Provider Demographics
NPI:1447280466
Name:KWAN, GEORGIANNA C (MS CCC-A)
Entity type:Individual
Prefix:MS
First Name:GEORGIANNA
Middle Name:C
Last Name:KWAN
Suffix:
Gender:F
Credentials:MS CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 863
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33731-0863
Mailing Address - Country:US
Mailing Address - Phone:727-504-7973
Mailing Address - Fax:
Practice Address - Street 1:13000 BRUCE B DOWNS BLVD # 126
Practice Address - Street 2:JAMES A. HALEY VETERAN'S HOSPITAL
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33612-4745
Practice Address - Country:US
Practice Address - Phone:813-972-7529
Practice Address - Fax:813-978-5812
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-04
Last Update Date:2008-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAY563231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist