| NPI | 1770961104 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SAGE JACKSON Speech Language Pathologist 404-514-6654 |
| Organization Subpart ? | No |
| Primary Taxonomy | 235Z00000X Speech-Language Pathologist, (Licence: GA SLP007584) |
| Enumeration Date | 2015-05-18 |
| Last Update Date | 2015-05-18 |