Provider Demographics
NPI:1912106055
Name:SIMPLY SPEECH OF GEORGIA
Entity Type:Organization
Organization Name:SIMPLY SPEECH OF GEORGIA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH PATHOLOGIST/PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:REBEKAH
Authorized Official - Middle Name:
Authorized Official - Last Name:O'CONNOR
Authorized Official - Suffix:
Authorized Official - Credentials:MS,CCC,SLP
Authorized Official - Phone:770-294-5472
Mailing Address - Street 1:3295 LAKE SEMINOLE PL
Mailing Address - Street 2:
Mailing Address - City:BUFORD
Mailing Address - State:GA
Mailing Address - Zip Code:30519-3781
Mailing Address - Country:US
Mailing Address - Phone:770-294-5472
Mailing Address - Fax:
Practice Address - Street 1:3295 LAKE SEMINOLE PL
Practice Address - Street 2:
Practice Address - City:BUFORD
Practice Address - State:GA
Practice Address - Zip Code:30519-3781
Practice Address - Country:US
Practice Address - Phone:770-294-5472
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-17
Last Update Date:2007-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty