Individual
MISS TAMEKA BLANETTE BACON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
7327 VIGO DR, LITHONIA, GA 30058-5966
(404) 808-2323
Mailing address
7327 VIGO DR, LITHONIA, GA 30058-5966
(404) 808-2323
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
—
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003140688B
—
GA
Enumeration date
05/21/2007
Last updated
03/03/2016
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