Provider Demographics
NPI:1134714074
Name:SWALLOWING DOCTOR
Entity type:Organization
Organization Name:SWALLOWING DOCTOR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:KWESI
Authorized Official - Middle Name:
Authorized Official - Last Name:ADEDEJI-WATSON
Authorized Official - Suffix:
Authorized Official - Credentials:EED-SLP
Authorized Official - Phone:678-545-0272
Mailing Address - Street 1:1691 PHOENIX BLVD STE 395
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30349-5511
Mailing Address - Country:US
Mailing Address - Phone:678-545-0273
Mailing Address - Fax:
Practice Address - Street 1:1691 PHOENIX BLVD STE 395
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30349-5511
Practice Address - Country:US
Practice Address - Phone:678-545-0273
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-03
Last Update Date:2021-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty