Provider Demographics
NPI:1821444043
Name:GEORGIA SPEECH PATHOLOGY, LLC
Entity Type:Organization
Organization Name:GEORGIA SPEECH PATHOLOGY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:TRAMONTANA
Authorized Official - Suffix:
Authorized Official - Credentials:MS, CCC-SLP
Authorized Official - Phone:570-506-5421
Mailing Address - Street 1:1616 PIEDMONT AVE NE
Mailing Address - Street 2:APT. P12
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30324-5298
Mailing Address - Country:US
Mailing Address - Phone:570-506-5421
Mailing Address - Fax:
Practice Address - Street 1:1616 PIEDMONT AVE NE
Practice Address - Street 2:APT. P12
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30324-5298
Practice Address - Country:US
Practice Address - Phone:570-506-5421
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-06
Last Update Date:2016-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP004945235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty