Provider Demographics
NPI:1659310852
Name:OLLIFF, DAVID C (CCC/SLP)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:C
Last Name:OLLIFF
Suffix:
Gender:M
Credentials:CCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2673 COLGAN CT SE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30317-2949
Mailing Address - Country:US
Mailing Address - Phone:404-373-2795
Mailing Address - Fax:
Practice Address - Street 1:470 CLARA DR
Practice Address - Street 2:
Practice Address - City:WHITESBURG
Practice Address - State:GA
Practice Address - Zip Code:30185-2531
Practice Address - Country:US
Practice Address - Phone:770-214-0536
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-05
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP004025235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist