Provider Demographics
NPI:1285912345
Name:COMMUNICATION CONSULTANTS
Entity type:Organization
Organization Name:COMMUNICATION CONSULTANTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH- LANGUAGE PATHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:CARMEN
Authorized Official - Middle Name:MELTON
Authorized Official - Last Name:DOUGLAS
Authorized Official - Suffix:
Authorized Official - Credentials:MED
Authorized Official - Phone:404-317-4140
Mailing Address - Street 1:1415 HIGHWAY 85 N
Mailing Address - Street 2:SUITE 310-172
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30214-7738
Mailing Address - Country:US
Mailing Address - Phone:404-317-4140
Mailing Address - Fax:770-603-9072
Practice Address - Street 1:10354 SHEPPERTON CT
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:GA
Practice Address - Zip Code:30238-7875
Practice Address - Country:US
Practice Address - Phone:404-317-4140
Practice Address - Fax:770-603-5898
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-23
Last Update Date:2011-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP005253235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000946558DMedicaid