Basic Information
| Provider Information | |||||||||
| NPI: | 1396178059 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ZIMIN | ||||||||
| FirstName: | BRANDI | ||||||||
| MiddleName: | SHAY | ||||||||
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| Credential: | MS - SLP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4403 WOODFIELD DR | ||||||||
| Address2: | |||||||||
| City: | HAHIRA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 316323111 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6784783450 | ||||||||
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| Practice Location | |||||||||
| Address1: | 706 N PARRISH AVE | ||||||||
| Address2: | |||||||||
| City: | ADEL | ||||||||
| State: | GA | ||||||||
| PostalCode: | 31620 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2298968000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/17/2013 | ||||||||
| LastUpdateDate: | 01/31/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | SZ6211 | FL | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
No ID Information.