Provider Demographics
NPI:1225108129
Name:DAVIS, STEPHANIE KAY (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:KAY
Last Name:DAVIS
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6075 ATLANTIC BLVD
Mailing Address - Street 2:SUITE G-1
Mailing Address - City:NORCROSS
Mailing Address - State:GA
Mailing Address - Zip Code:30071-1349
Mailing Address - Country:US
Mailing Address - Phone:770-209-9826
Mailing Address - Fax:770-209-9876
Practice Address - Street 1:6075 ATLANTIC BLVD
Practice Address - Street 2:SUITE G-1
Practice Address - City:NORCROSS
Practice Address - State:GA
Practice Address - Zip Code:30071-1349
Practice Address - Country:US
Practice Address - Phone:770-209-9826
Practice Address - Fax:770-209-9876
Is Sole Proprietor?:No
Enumeration Date:2006-11-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP006373235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist