| NPI | 1063063592 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHANNON D. BRAGG Speech Language Pathologist 770-871-6338 |
| Organization Subpart ? | No |
| Primary Taxonomy | 235Z00000X Speech-Language Pathologist, |
| Enumeration Date | 2019-09-25 |
| Last Update Date | 2019-09-25 |