Individual
MR. GENE RUSSELL TACKETT JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CCC-SLP
Contact information
Practice address
1111 HUNT RD, DANIELSVILLE, GA 30633-5543
(706) 424-8191
Mailing address
1111 HUNT RD, DANIELSVILLE, GA 30633-5543
(706) 424-8191
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
SLP007430
GA
Other
Enumeration date
09/13/2010
Last updated
09/13/2010
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