Individual
NIA REDD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
X
Contact information
Practice address
780 MEMORIAL DR SE APT 622, ATLANTA, GA 30316-1751
(310) 415-9101
Mailing address
145 HUNTCLIFF TRL, ELLENWOOD, GA 30294-2597
(310) 415-9101
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
12809
GA
Other
Enumeration date
03/04/2025
Last updated
03/05/2025
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