| NPI | 1235584020 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DEMETRIA L JACKSON Owner 912-571-6022 |
| Organization Subpart ? | No |
| Primary Taxonomy | 235Z00000X Speech-Language Pathologist, (Licence: GA SLP007195) |
| Enumeration Date | 2016-04-28 |
| Last Update Date | 2022-02-24 |