Provider Demographics
NPI:1053871095
Name:KRYSTAL TEMPLES GAITHER
Entity type:Organization
Organization Name:KRYSTAL TEMPLES GAITHER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/SLP
Authorized Official - Prefix:
Authorized Official - First Name:KRYSTAL
Authorized Official - Middle Name:
Authorized Official - Last Name:GAITHER
Authorized Official - Suffix:
Authorized Official - Credentials:MED CCC-SLP
Authorized Official - Phone:229-686-0771
Mailing Address - Street 1:736 HIGHLAND CIR
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31639-5807
Mailing Address - Country:US
Mailing Address - Phone:229-686-0771
Mailing Address - Fax:
Practice Address - Street 1:736 HIGHLAND CIR
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:GA
Practice Address - Zip Code:31639-5807
Practice Address - Country:US
Practice Address - Phone:229-686-0771
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-25
Last Update Date:2019-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA577891570Medicaid