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Individual

MS. CARMEN MELTON DOUGLAS

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
MED

Contact information

Practice address
10354 SHEPPERTON COURT, JONESBORO, GA 30238
(404) 317-4140
(770) 603-9072
Mailing address
1415 HIGHWAY 85 N, # 310-172, FAYETTEVILLE, GA 30214-7738
(404) 317-4140
(770) 603-9072

Taxonomy

Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
SLP005253
GA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
000946558D
GA
Enumeration date
02/12/2009
Last updated
08/07/2011
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