Individual
ASHLEY MOATES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2089 TERON TRCE STE 120, DACULA, GA 30019-1609
(770) 904-6009
Mailing address
2089 TERON TRCE STE 120, DACULA, GA 30019-1609
(770) 904-6009
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
PCET003201
GA
390200000X
Student in an Organized Health Care Education/Training Program
PCET003201
GA
Other
Enumeration date
08/28/2020
Last updated
08/31/2020
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