Individual
MRS. MISTY VANLANDINGHAM FOUNTAIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CCC-SLP
Contact information
Practice address
1685 HARLINGTON RD, SMYRNA, GA 30082-5052
(770) 432-0395
Mailing address
5891 BUCKNER CREEK DR, MABLETON, GA 30126-2795
(404) 281-4126
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
SLP005004
GA
Other
Enumeration date
08/11/2011
Last updated
08/11/2011
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