Organization
SAGE THERAPY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SAGE JACKSON (SPEECH LANGUAGE PATHOLOGIST)
(404) 514-6654
Entity
Organization
Contact information
Practice address
2485 VISTORIA DR, CUMMING, GA 30041-1579
(678) 977-7874
Mailing address
2485 VISTORIA DR, CUMMING, GA 30041-1579
(678) 977-7874
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
SLP007584
GA
Other
Enumeration date
05/18/2015
Last updated
05/18/2015
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