Provider Demographics
NPI:1619123064
Name:ELIZABETH H. FESTER
Entity Type:Organization
Organization Name:ELIZABETH H. FESTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:HOUSEMAN
Authorized Official - Last Name:FESTER
Authorized Official - Suffix:
Authorized Official - Credentials:MS CCC-SLP
Authorized Official - Phone:404-433-4818
Mailing Address - Street 1:440 S BURGESS TRL
Mailing Address - Street 2:
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30004-0859
Mailing Address - Country:US
Mailing Address - Phone:404-433-4818
Mailing Address - Fax:770-442-5924
Practice Address - Street 1:440 S BURGESS TRL
Practice Address - Street 2:
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30004-0859
Practice Address - Country:US
Practice Address - Phone:404-433-4818
Practice Address - Fax:770-442-5924
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-15
Last Update Date:2008-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA1386235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000595933DMedicaid