Provider Demographics
NPI:1346693801
Name:GEORGE, TINA (CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:TINA
Middle Name:
Last Name:GEORGE
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 PROVIDENCE OAKS CIR
Mailing Address - Street 2:
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30009-6814
Mailing Address - Country:US
Mailing Address - Phone:917-863-3142
Mailing Address - Fax:
Practice Address - Street 1:200 PROVIDENCE OAKS CIR
Practice Address - Street 2:
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30009-6814
Practice Address - Country:US
Practice Address - Phone:917-863-3142
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-20
Last Update Date:2016-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP009357235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist