Provider Demographics
NPI:1922369339
Name:PRINCE, ANESHEIA CEASAR (AUD)
Entity Type:Individual
Prefix:DR
First Name:ANESHEIA
Middle Name:CEASAR
Last Name:PRINCE
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5555 PEACHTREE DUNWOODY RD NE
Mailing Address - Street 2:STE 125
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30342-1710
Mailing Address - Country:US
Mailing Address - Phone:404-255-2918
Mailing Address - Fax:404-255-5837
Practice Address - Street 1:5555 PEACHTREE DUNWOODY RD NE
Practice Address - Street 2:STE 125
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30342-1710
Practice Address - Country:US
Practice Address - Phone:404-255-2918
Practice Address - Fax:404-255-5837
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-01
Last Update Date:2017-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAUD003899231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003124990Medicaid