Basic Information
| Provider Information | |||||||||
| NPI: | 1255473229 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HAMBRECHT | ||||||||
| FirstName: | GEORGIA | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | SLP-CCC SP | ||||||||
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| Mailing Information | |||||||||
| Address1: | G 30 MCKEE | ||||||||
| Address2: | |||||||||
| City: | CULLLOWHEE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 28723 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8282273279 | ||||||||
| FaxNumber: | 8282277456 | ||||||||
| Practice Location | |||||||||
| Address1: | G 30 MCKEE | ||||||||
| Address2: | |||||||||
| City: | CULLLOWHEE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 28723 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8282273279 | ||||||||
| FaxNumber: | 8282277456 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/13/2007 | ||||||||
| LastUpdateDate: | 07/09/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | 22003016A | NC | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
ID Information
| ID | Type | State | Issuer | Description | 7412194 | 05 | NC | MEDICAID |