Individual
MRS. SUE FILLINGIM FORD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.A.
Contact information
Practice address
110 CARLTON ST, ATHENS, GA 30602-5004
(706) 542-8414
Mailing address
1207 RIVERMIST DR SW, LILBURN, GA 30047-7513
(770) 978-5528
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
001189
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
001189
STATE LICENSE NUMBER
GA
Enumeration date
08/25/2006
Last updated
07/08/2007
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