Provider Demographics
NPI:1659083202
Name:GREATER ATLANTA SPEECH AND SWALLOW SERVICES
Entity Type:Organization
Organization Name:GREATER ATLANTA SPEECH AND SWALLOW SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ARISA
Authorized Official - Middle Name:
Authorized Official - Last Name:STEWART-NGARUIYA
Authorized Official - Suffix:
Authorized Official - Credentials:M ED CCC-SLP
Authorized Official - Phone:470-668-0229
Mailing Address - Street 1:300 ASHLEY PARK BLVD APT 2011
Mailing Address - Street 2:
Mailing Address - City:NEWNAN
Mailing Address - State:GA
Mailing Address - Zip Code:30263-6419
Mailing Address - Country:US
Mailing Address - Phone:470-668-0229
Mailing Address - Fax:470-668-0229
Practice Address - Street 1:15 PERRY ST STE 399
Practice Address - Street 2:
Practice Address - City:NEWNAN
Practice Address - State:GA
Practice Address - Zip Code:30263-1918
Practice Address - Country:US
Practice Address - Phone:470-668-0229
Practice Address - Fax:470-668-0229
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-14
Last Update Date:2022-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0700XAmbulatory Health Care FacilitiesClinic/CenterHearing and Speech
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003220726BMedicaid