Basic Information
| Provider Information | |||||||||
| NPI: | 1548997000 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CARROLL | ||||||||
| FirstName: | SYDNEY | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2959 SHARPSBURG MCCULLUM RD UNIT C | ||||||||
| Address2: | |||||||||
| City: | NEWNAN | ||||||||
| State: | GA | ||||||||
| PostalCode: | 302652299 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7706830250 | ||||||||
| FaxNumber: | 7706834250 | ||||||||
| Practice Location | |||||||||
| Address1: | 2959 SHARPSBURG MCCULLUM RD UNIT C | ||||||||
| Address2: | |||||||||
| City: | NEWNAN | ||||||||
| State: | GA | ||||||||
| PostalCode: | 302652299 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7706830250 | ||||||||
| FaxNumber: | 7706834250 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/04/2022 | ||||||||
| LastUpdateDate: | 08/04/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/04/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | PCET003465 | GA | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
No ID Information.