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Individual

TASIA CARROLL

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F

Contact information

Practice address
115 MOUNTAIN LAUREL WAY, FAYETTEVILLE, GA 30215-7743
(770) 856-9403
Mailing address
PO BOX 143762, FAYETTEVILLE, GA 30214-6537
(770) 856-9403

Taxonomy

Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
SLP005699
GA

Other

Enumeration date
06/26/2015
Last updated
06/26/2015
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