Provider Demographics
NPI:1215288923
Name:MAMAH, THERESA EVELYN (AUD)
Entity type:Individual
Prefix:DR
First Name:THERESA
Middle Name:EVELYN
Last Name:MAMAH
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4380 GEORGETOWN SQ
Mailing Address - Street 2:SUITE 1002
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30338-6254
Mailing Address - Country:US
Mailing Address - Phone:770-220-8400
Mailing Address - Fax:770-234-9979
Practice Address - Street 1:5673 PEACHTREE DUNWOODY RD NE
Practice Address - Street 2:SUITE 150
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30342-1731
Practice Address - Country:US
Practice Address - Phone:404-297-4230
Practice Address - Fax:404-252-7255
Is Sole Proprietor?:No
Enumeration Date:2012-09-21
Last Update Date:2012-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAUD003910231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist