Provider Demographics
NPI:1780759522
Name:CANADY, CHRISTINA BELL (MCD, CCC SLP)
Entity type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:BELL
Last Name:CANADY
Suffix:
Gender:F
Credentials:MCD, CCC SLP
Other - Prefix:
Other - First Name:CHRISTINA
Other - Middle Name:DAWN
Other - Last Name:BELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MCD, CCC SLP
Mailing Address - Street 1:601 N BELAIR SQ
Mailing Address - Street 2:SUITE 19
Mailing Address - City:EVANS
Mailing Address - State:GA
Mailing Address - Zip Code:30809-4321
Mailing Address - Country:US
Mailing Address - Phone:706-364-1486
Mailing Address - Fax:706-364-1487
Practice Address - Street 1:601 N BELAIR SQ
Practice Address - Street 2:SUITE 19
Practice Address - City:EVANS
Practice Address - State:GA
Practice Address - Zip Code:30809-4321
Practice Address - Country:US
Practice Address - Phone:706-364-1486
Practice Address - Fax:706-364-1487
Is Sole Proprietor?:No
Enumeration Date:2006-11-21
Last Update Date:2009-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL5A8617235Z00000X
GASLP006956235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL889615100Medicaid