1467695734 NPI number — SPEECH ASSESSMENT CENTER, INC.

Table of content: (NPI 1467695734)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1467695734 NPI number — SPEECH ASSESSMENT CENTER, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SPEECH ASSESSMENT CENTER, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1467695734
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/11/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
210 MCINTOSH PLACE DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FAYETTEVILLE
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30214-7384
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
678-438-7168
Provider Business Mailing Address Fax Number:
707-377-8097

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
175 BRADFORD SQ STE A
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FAYETTEVILLE
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30215-1967
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
678-438-7168
Provider Business Practice Location Address Fax Number:
470-377-8097
Provider Enumeration Date:
04/15/2009

Additional Information

Authorized Official

Authorized Official Last Name:
NELSON
Authorized Official First Name:
JAMES
Authorized Official Middle Name:
Authorized Official Title or Position:
CREDENTIALING
Authorized Official Telephone Number:
678-438-7168

Provider Taxonomy Codes

  • Taxonomy code: 235Z00000X , with the licence number:  SLP006202 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 003209834D , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".




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