Provider Demographics
NPI:1043382120
Name:LAMBERT, PAIGE DIANE (MA, CCC-A)
Entity Type:Individual
Prefix:MRS
First Name:PAIGE
Middle Name:DIANE
Last Name:LAMBERT
Suffix:
Gender:F
Credentials:MA, CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 CLINIC AVE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:CARROLLTON
Mailing Address - State:GA
Mailing Address - Zip Code:30117-4401
Mailing Address - Country:US
Mailing Address - Phone:770-832-1488
Mailing Address - Fax:770-836-0051
Practice Address - Street 1:150 CLINIC AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:CARROLLTON
Practice Address - State:GA
Practice Address - Zip Code:30117-4401
Practice Address - Country:US
Practice Address - Phone:770-832-1488
Practice Address - Fax:770-836-0051
Is Sole Proprietor?:No
Enumeration Date:2006-11-14
Last Update Date:2009-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA3855231H00000X
GA3588237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000937538EMedicaid
GA000937538DMedicaid
GAQ65623Medicare UPIN
GA000937538DMedicaid