Provider Demographics
NPI:1477545028
Name:FRATES, MERIDITH HOPE (MED, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:MERIDITH
Middle Name:HOPE
Last Name:FRATES
Suffix:
Gender:F
Credentials:MED, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3615 BRASELTON HWY
Mailing Address - Street 2:SUITE 103
Mailing Address - City:DACULA
Mailing Address - State:GA
Mailing Address - Zip Code:30019-5907
Mailing Address - Country:US
Mailing Address - Phone:678-377-9634
Mailing Address - Fax:678-377-9609
Practice Address - Street 1:3615 BRASELTON HWY
Practice Address - Street 2:SUITE 103
Practice Address - City:DACULA
Practice Address - State:GA
Practice Address - Zip Code:30019-5907
Practice Address - Country:US
Practice Address - Phone:678-377-9634
Practice Address - Fax:678-377-9609
Is Sole Proprietor?:No
Enumeration Date:2005-08-19
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP005601235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA7554700OtherAETNA
GA306025Medicaid
GA52143363-002OtherBLUE CROSS & BLUE SHIELD
GA10033356Medicaid