Organization
SPEECH TEACHERS OF NORTH GEORGIA LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LAKEISHA JACKSON (OWNER)
(404) 939-5976
Entity
Organization
Contact information
Practice address
225 CREEKSTONE RDG STE 25, WOODSTOCK, GA 30188-3744
(404) 939-5976
(404) 920-3496
Mailing address
744 NOAH DR STE 113-374, JASPER, GA 30143-8705
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
—
—
225X00000X
Occupational Therapist
—
—
235Z00000X
Speech-Language Pathologist
—
—
261QH0700X
Hearing and Speech Clinic/Center
—
—
261QR0400X
Rehabilitation Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000
NONE
—
Enumeration date
07/05/2018
Last updated
10/24/2023
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