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Organization
AGAPE SPEECH THERAPY, LLC
Active
Organization
AGAPE SPEECH THERAPY, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. LINDA H RADCLIFFE SLP (DIRECTOR)
(770) 776-6013
Entity
Organization
Contact information
Practice address
101 DEVANT ST, SUITE 703, FAYETTEVILLE, GA 30214-2710
(770) 776-6013
(877) 469-5558
Mailing address
101 DEVANT ST, SUITE 703, FAYETTEVILLE, GA 30214-2710
(770) 776-6013
(877) 469-5558
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003125104B
—
GA
01
—
12362429
CAQH
GA
01
—
202G155590
MEDICARE
GA
Enumeration date
01/17/2012
Last updated
06/04/2014
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