Provider Demographics
NPI:1417234808
Name:RAMOS, LIZ MINNETTE (AUD)
Entity Type:Individual
Prefix:
First Name:LIZ
Middle Name:MINNETTE
Last Name:RAMOS
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5673 PEACHTREE DUNWOODY RD
Mailing Address - Street 2:SUITE 150
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30342-1771
Mailing Address - Country:US
Mailing Address - Phone:404-297-1780
Mailing Address - Fax:404-252-7255
Practice Address - Street 1:484 IRVIN CT STE 140
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30030-5406
Practice Address - Country:US
Practice Address - Phone:404-297-4230
Practice Address - Fax:404-297-4252
Is Sole Proprietor?:No
Enumeration Date:2011-11-14
Last Update Date:2018-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAUD003888231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003121861IMedicaid
GA003121861IMedicaid