Provider Demographics
NPI:1992439608
Name:RUTH, TAMEKIA (MA, CCC-SLP)
Entity type:Individual
Prefix:
First Name:TAMEKIA
Middle Name:
Last Name:RUTH
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2700 BRASELTON HWY STE 3
Mailing Address - Street 2:
Mailing Address - City:DACULA
Mailing Address - State:GA
Mailing Address - Zip Code:30019-3263
Mailing Address - Country:US
Mailing Address - Phone:678-208-7349
Mailing Address - Fax:
Practice Address - Street 1:2700 BRASELTON HWY STE 3
Practice Address - Street 2:
Practice Address - City:DACULA
Practice Address - State:GA
Practice Address - Zip Code:30019-3263
Practice Address - Country:US
Practice Address - Phone:678-208-7349
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-11
Last Update Date:2022-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP012132235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist