Provider Demographics
NPI:1659338242
Name:NUNNERY, TASHA NICOLE (MED, CCC-SLP)
Entity Type:Individual
Prefix:MISS
First Name:TASHA
Middle Name:NICOLE
Last Name:NUNNERY
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 1:3052 AVIATOR CIR
Mailing Address - Street 2:
Mailing Address - City:SNELLVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30039-5446
Mailing Address - Country:US
Mailing Address - Phone:678-622-8525
Mailing Address - Fax:770-982-5714
Practice Address - Street 1:3052 AVIATOR CIR
Practice Address - Street 2:
Practice Address - City:SNELLVILLE
Practice Address - State:GA
Practice Address - Zip Code:30039-5446
Practice Address - Country:US
Practice Address - Phone:678-622-8525
Practice Address - Fax:770-982-5714
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-27
Last Update Date:2012-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP006139235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist