Provider Demographics
NPI:1679602841
Name:SEMANTIX, INC
Entity Type:Organization
Organization Name:SEMANTIX, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH PATHOLOGIST
Authorized Official - Prefix:MR
Authorized Official - First Name:COREY
Authorized Official - Middle Name:EVONT
Authorized Official - Last Name:EVANS
Authorized Official - Suffix:
Authorized Official - Credentials:MA CCC-SLP
Authorized Official - Phone:770-492-1313
Mailing Address - Street 1:2185 NORTHLAKE PKWY
Mailing Address - Street 2:SUITE 110
Mailing Address - City:TUCKER
Mailing Address - State:GA
Mailing Address - Zip Code:30084-4126
Mailing Address - Country:US
Mailing Address - Phone:770-492-1313
Mailing Address - Fax:770-492-1235
Practice Address - Street 1:2185 NORTHLAKE PKWY
Practice Address - Street 2:SUITE 110
Practice Address - City:TUCKER
Practice Address - State:GA
Practice Address - Zip Code:30084-4126
Practice Address - Country:US
Practice Address - Phone:770-492-1313
Practice Address - Fax:770-492-1235
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP005335235Z00000X
GASLP 005885235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00955028DMedicaid