Provider Demographics
NPI:1558502799
Name:KAMATH, SUCHETA A (MA, MA, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:SUCHETA
Middle Name:A
Last Name:KAMATH
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Gender:F
Credentials:MA, MA, CCC-SLP
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Mailing Address - Street 1:6100 LAKE FORREST DR NW
Mailing Address - Street 2:SUITE 108
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30328-3822
Mailing Address - Country:US
Mailing Address - Phone:404-493-0962
Mailing Address - Fax:404-257-9768
Practice Address - Street 1:6100 LAKE FORREST DR NW
Practice Address - Street 2:SUITE 108
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30328-3822
Practice Address - Country:US
Practice Address - Phone:404-493-0962
Practice Address - Fax:404-257-9768
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-18
Last Update Date:2009-03-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GASLP005116235Z00000X
MA3769235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist