Provider Demographics
NPI:1730901240
Name:GEORGE, PRISTINA ROSE (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:PRISTINA
Middle Name:ROSE
Last Name:GEORGE
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2140 BUFORD HWY STE 109
Mailing Address - Street 2:
Mailing Address - City:BUFORD
Mailing Address - State:GA
Mailing Address - Zip Code:30518-6121
Mailing Address - Country:US
Mailing Address - Phone:470-589-1742
Mailing Address - Fax:
Practice Address - Street 1:2140 BUFORD HWY STE 109
Practice Address - Street 2:
Practice Address - City:BUFORD
Practice Address - State:GA
Practice Address - Zip Code:30518-6121
Practice Address - Country:US
Practice Address - Phone:470-589-1742
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-26
Last Update Date:2024-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP013334235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist