Basic Information
| Provider Information | |||||||||
| NPI: | 1215288923 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MAMAH | ||||||||
| FirstName: | THERESA | ||||||||
| MiddleName: | EVELYN | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | AUD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4380 GEORGETOWN SQ | ||||||||
| Address2: | SUITE 1002 | ||||||||
| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303386254 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7702208400 | ||||||||
| FaxNumber: | 7702349979 | ||||||||
| Practice Location | |||||||||
| Address1: | 5673 PEACHTREE DUNWOODY RD NE | ||||||||
| Address2: | SUITE 150 | ||||||||
| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303421731 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4042974230 | ||||||||
| FaxNumber: | 4042527255 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/21/2012 | ||||||||
| LastUpdateDate: | 10/01/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 231H00000X | AUD003910 | GA | Y | Speech, Language and Hearing Service Providers | Audiologist |
No ID Information.