Provider Demographics
NPI:1922398890
Name:BROOKS, DAVID C (MA, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:C
Last Name:BROOKS
Suffix:
Gender:M
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6478 PUTNAM FORD DR
Mailing Address - Street 2:SUITE 116
Mailing Address - City:WOODSTOCK
Mailing Address - State:GA
Mailing Address - Zip Code:30189-6984
Mailing Address - Country:US
Mailing Address - Phone:678-494-8045
Mailing Address - Fax:678-494-8047
Practice Address - Street 1:6478 PUTNAM FORD DR
Practice Address - Street 2:SUITE 116
Practice Address - City:WOODSTOCK
Practice Address - State:GA
Practice Address - Zip Code:30189-6984
Practice Address - Country:US
Practice Address - Phone:678-494-8045
Practice Address - Fax:678-494-8047
Is Sole Proprietor?:No
Enumeration Date:2011-04-13
Last Update Date:2011-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP006427235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist