Individual
MARTHA BANKS FAY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.ED.
Contact information
Practice address
1305 JENNINGS MILL RD, WATKINSVILLE, GA 30677-7238
(706) 552-1999
Mailing address
550 TALMADGE DR, ATHENS, GA 30606-2746
(706) 593-7526
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
SLP010210
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003216567A
—
GA
Enumeration date
02/18/2019
Last updated
02/18/2020
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