Provider Demographics
NPI:1467792135
Name:MEREDITH, MARCELLA PAIGE (MM,MS, CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:MARCELLA
Middle Name:PAIGE
Last Name:MEREDITH
Suffix:
Gender:F
Credentials:MM,MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2336 WISTERIA DR
Mailing Address - Street 2:SUITE 240
Mailing Address - City:SNELLVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30078-6191
Mailing Address - Country:US
Mailing Address - Phone:770-995-9600
Mailing Address - Fax:678-922-7124
Practice Address - Street 1:2336 WISTERIA DR
Practice Address - Street 2:SUITE240
Practice Address - City:SNELLVILLE
Practice Address - State:GA
Practice Address - Zip Code:30078-6191
Practice Address - Country:US
Practice Address - Phone:770-995-9600
Practice Address - Fax:678-922-7124
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-18
Last Update Date:2015-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP008511235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist