Provider Demographics
NPI:1689357121
Name:GERETY, MARY CAILAN
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:CAILAN
Last Name:GERETY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:777 MEMORIAL DR SE UNIT 445
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30316-1394
Mailing Address - Country:US
Mailing Address - Phone:850-766-1485
Mailing Address - Fax:
Practice Address - Street 1:4900 IVEY RD NW STE 1720
Practice Address - Street 2:
Practice Address - City:ACWORTH
Practice Address - State:GA
Practice Address - Zip Code:30101-4101
Practice Address - Country:US
Practice Address - Phone:770-917-5737
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-10
Last Update Date:2023-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist