Basic Information
| Provider Information | |||||||||
| NPI: | 1245963420 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MAYES | ||||||||
| FirstName: | SARA | ||||||||
| MiddleName: | ELIZABETH | ||||||||
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| Credential: | M.ED. CF-SLP | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1220 | ||||||||
| Address2: | |||||||||
| City: | RINCON | ||||||||
| State: | GA | ||||||||
| PostalCode: | 313261220 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9126676468 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 5723 GEORGIA HIGHWAY 21 S | ||||||||
| Address2: | |||||||||
| City: | RINCON | ||||||||
| State: | GA | ||||||||
| PostalCode: | 313265554 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9126676468 | ||||||||
| FaxNumber: | 9123244241 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/06/2022 | ||||||||
| LastUpdateDate: | 07/06/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 07/06/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | PCET003628 | GA | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
No ID Information.