Organization
RHONDA LANE GRAY THERAPY SERVICES,INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RHONDA LANE GRAY M.A.C.C.C. S.L.P. (SPEECH-LANGUAGE PATHOLOGIST)
(706) 833-7376
Entity
Organization
Contact information
Practice address
601 N BELAIR SQ, #19, EVANS, GA 30809-4321
(706) 833-7376
Mailing address
1036 BARRETT DR, EVANS, GA 30809-4029
(706) 833-7376
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
SLP004870
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000897993
—
GA
01
—
01900609
AMERIGROUP
GA
01
—
11885042
CAQH
—
Enumeration date
04/30/2015
Last updated
04/30/2015
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