Individual
MARY E ETHRIDGE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
121B LEE ST, CARROLLTON, GA 30117-3314
(770) 830-8622
(770) 832-9031
Mailing address
121B LEE ST, CARROLLTON, GA 30117-3314
(770) 830-8622
(770) 832-9031
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
SLP007220
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
SLP007220
SPEECH, LANGUAGE AND PATHOLOGIST
GA
Enumeration date
03/30/2010
Last updated
03/30/2010
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