Provider Demographics
NPI:1891922647
Name:GRANT, ROBINE AURELIA (SLP)
Entity Type:Individual
Prefix:
First Name:ROBINE
Middle Name:AURELIA
Last Name:GRANT
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:ROBINE
Other - Middle Name:AURELIA
Other - Last Name:DAVIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:SLP
Mailing Address - Street 1:4153 FLAT SHOALS PKWY
Mailing Address - Street 2:BUILDING C; SUITE 300A
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30034-4106
Mailing Address - Country:US
Mailing Address - Phone:404-244-9477
Mailing Address - Fax:404-244-9478
Practice Address - Street 1:4153 FLAT SHOALS PKWY
Practice Address - Street 2:BUILDING C; SUITE 300A
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30034-4106
Practice Address - Country:US
Practice Address - Phone:404-244-9477
Practice Address - Fax:404-244-9478
Is Sole Proprietor?:No
Enumeration Date:2009-06-19
Last Update Date:2015-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP004151235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist