Individual
EVAN ANDERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
75 RED GATE TRL, CANTON, GA 30115-7525
(404) 644-3917
Mailing address
1130 BRENTON DR NW, KENNESAW, GA 30144-2761
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
009889
GA
Other
Enumeration date
05/16/2018
Last updated
05/16/2018
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