| Doctor Name: | JOHN LOTT SANDIDGE |
| NPI Number: | 1104122373 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | SLP |
| License Number: | SLP004077 |
| Business Practice Address: | 640 Glen Iris Dr Ne Unit 508 Atlanta, GA - 303082723 |
| Business Phone Number: | 4042775813 |
| Business Fax Number: | |
| Mailing Address: | Po Box 1000, Dept 128 MEMPHIS |
| State: | TN |
| Postal Code: | 381480128 |
| Phone Number: | 9018210338 |
| Fax Number: | 9018210341 |
| NPI Enumeration Date: | 02/04/2011 |
| NPI Last Update Date: | 03/03/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 235Z00000X |
| License Number: | SLP004077 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | GA |
| Taxonomy Type: | Speech, Language and Hearing Service Providers |
| Taxonomy Classification: | Speech-Language Pathologist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | A speech pathologist is a person qualified by a master |