Provider Demographics
NPI:1932432168
Name:MANOR OF SPEAKING, LLC
Entity type:Organization
Organization Name:MANOR OF SPEAKING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH-LANGUAGE PATHOLOGIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:COURTNEY
Authorized Official - Middle Name:EDMUNDS
Authorized Official - Last Name:JACOBS
Authorized Official - Suffix:
Authorized Official - Credentials:CCC
Authorized Official - Phone:229-928-8202
Mailing Address - Street 1:511 W FORSYTH ST
Mailing Address - Street 2:SUITE E
Mailing Address - City:AMERICUS
Mailing Address - State:GA
Mailing Address - Zip Code:31709-3465
Mailing Address - Country:US
Mailing Address - Phone:229-928-8202
Mailing Address - Fax:229-928-8205
Practice Address - Street 1:511 W FORSYTH ST
Practice Address - Street 2:SUITE E
Practice Address - City:AMERICUS
Practice Address - State:GA
Practice Address - Zip Code:31709-3465
Practice Address - Country:US
Practice Address - Phone:229-928-8202
Practice Address - Fax:229-928-8205
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-04
Last Update Date:2009-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP006018261QH0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0700XAmbulatory Health Care FacilitiesClinic/CenterHearing and Speech
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA414174596BMedicaid
GA1205012911OtherINDIVIDUAL NPI