Provider Demographics
NPI:1770093056
Name:NOYES, CANDICE GREENLAND
Entity type:Individual
Prefix:
First Name:CANDICE
Middle Name:GREENLAND
Last Name:NOYES
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 1:5136 MOUNT VERNON WAY
Mailing Address - Street 2:
Mailing Address - City:DUNWOODY
Mailing Address - State:GA
Mailing Address - Zip Code:30338-4248
Mailing Address - Country:US
Mailing Address - Phone:404-583-9496
Mailing Address - Fax:
Practice Address - Street 1:5136 MOUNT VERNON WAY
Practice Address - Street 2:
Practice Address - City:DUNWOODY
Practice Address - State:GA
Practice Address - Zip Code:30338-4248
Practice Address - Country:US
Practice Address - Phone:404-583-9496
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-02
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
235Z00000X
GASLP004608235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist