Skip Navigation

Provider Information for 1508068412

Please Note: Issuance of an NPI does not ensure or validate that the Health Care Provider is Licensed or Credentialed. For more information please refer to NPI: What You Need to Know

AMANDA P GOMEZ MS-CCC-SLP

Gender: FEMALE

Individual NPI: 1508068412

Calendar   Last Updated:  2019-03-06
  Certification Date: 

Details

Name Value
NPI 1508068412
Enumeration Date 2007-06-03
NPI Type 1 - Individual
Sole Proprietor NO
Status Active
Mailing Address 4530 NELSON BROGDON BLVD STE C
BUFORD, GA 30518-5407
United States

Phone: 678-820-9606 | Fax: 844-820-9616
View Map External Link
Primary Practice Address 4530 NELSON BROGDON BLVD STE C
BUFORD, GA 30518
United States

Phone: 678-820-9606 | Fax: 844-820-9616
View Map External Link
Health Information Exchange
Endpoint Type Endpoint Endpoint Description Use Content Type Affiliation Endpoint Location
Other Identifiers
Issuer State Number
MEDICAID GA 003134692A
Taxonomy
Primary Taxonomy Selected Taxonomy State License Number
Yes 235Z00000X - Speech-Language Pathologist GA SLP 006456