Provider Demographics
NPI:1457785396
Name:MEREDITH, MATTHEW (MA, MS)
Entity type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:
Last Name:MEREDITH
Suffix:
Gender:M
Credentials:MA, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:512 COTTONTAIL HOLW
Mailing Address - Street 2:
Mailing Address - City:FLINTSTONE
Mailing Address - State:GA
Mailing Address - Zip Code:30725-2781
Mailing Address - Country:US
Mailing Address - Phone:423-838-8828
Mailing Address - Fax:
Practice Address - Street 1:54 BATTLEFIELD CANOPY CIR
Practice Address - Street 2:
Practice Address - City:RINGGOLD
Practice Address - State:GA
Practice Address - Zip Code:30736-5052
Practice Address - Country:US
Practice Address - Phone:706-445-3655
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-28
Last Update Date:2024-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN4942235Z00000X
GA8474235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist