Organization
HERITAGE HEALTHCARE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SHONDRE CLEMONS (SPEECH PATHOLOGIST)
(334) 322-5793
Entity
Organization
Contact information
Practice address
3829 FLOYD RD, AUSTELL, GA 30106-8534
(770) 573-2592
Mailing address
1539 ANNA RUBY LN NW, KENNESAW, GA 30152-8205
Taxonomy
Speciality
Code
Description
License number
State
320700000X
Physical Disabilities Residential Treatment Facility
Primary
SLP006951
GA
Other
Enumeration date
07/19/2010
Last updated
07/19/2010
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