Provider Demographics
NPI:1992957187
Name:EVANS, TAVIA FOSTER (CCC-SLP)
Entity type:Individual
Prefix:
First Name:TAVIA
Middle Name:FOSTER
Last Name:EVANS
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:TAVIA
Other - Middle Name:
Other - Last Name:FOSTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3577 CHAMBLEE TUCKER RD
Mailing Address - Street 2:SUITE A #279
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30341-4422
Mailing Address - Country:US
Mailing Address - Phone:678-577-1768
Mailing Address - Fax:
Practice Address - Street 1:3756 LAVISTA RD
Practice Address - Street 2:SUITE 104
Practice Address - City:TUCKER
Practice Address - State:GA
Practice Address - Zip Code:30084-5614
Practice Address - Country:US
Practice Address - Phone:404-477-9400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-21
Last Update Date:2023-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP006900235Z00000X
MD08947235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist