Provider Demographics
NPI:1245854215
Name:GIVENS, EMILY (MED)
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:
Last Name:GIVENS
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:EMILY
Other - Middle Name:
Other - Last Name:DUBEAU
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MED
Mailing Address - Street 1:4080 MCGINNIS FERRY RD # B300S302
Mailing Address - Street 2:
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30005-3948
Mailing Address - Country:US
Mailing Address - Phone:770-410-7719
Mailing Address - Fax:770-410-9510
Practice Address - Street 1:4080 MCGINNIS FERRY RD # B300S302
Practice Address - Street 2:
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30005-3948
Practice Address - Country:US
Practice Address - Phone:770-410-7719
Practice Address - Fax:770-410-9510
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-04
Last Update Date:2020-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP011055235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist