Provider Demographics
NPI:1356754485
Name:EMRY, JAIME
Entity type:Individual
Prefix:MRS
First Name:JAIME
Middle Name:
Last Name:EMRY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3225 SHALLOWFORD RD
Mailing Address - Street 2:BLDG 1100, STE 1120
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30062-1266
Mailing Address - Country:US
Mailing Address - Phone:404-547-0825
Mailing Address - Fax:770-783-6618
Practice Address - Street 1:3225 SHALLOWFORD RD
Practice Address - Street 2:BLDG 1100, STE 1120
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30062-1266
Practice Address - Country:US
Practice Address - Phone:404-547-0825
Practice Address - Fax:770-783-6618
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-05
Last Update Date:2014-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP008280235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist