Provider Demographics
NPI:1881030971
Name:RAND, VIRGINIA (MED CCC-SLP)
Entity Type:Individual
Prefix:
First Name:VIRGINIA
Middle Name:
Last Name:RAND
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 1:2622 MCKINNON DR
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30030-4539
Mailing Address - Country:US
Mailing Address - Phone:678-429-3790
Mailing Address - Fax:678-279-5430
Practice Address - Street 1:2622 MCKINNON DR
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30030-4539
Practice Address - Country:US
Practice Address - Phone:678-429-3790
Practice Address - Fax:678-279-5430
Is Sole Proprietor?:No
Enumeration Date:2013-05-15
Last Update Date:2019-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP005762235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA764935686CMedicaid