Provider Demographics
NPI:1164161006
Name:CULBERSON, ALEX JEAN (AUD)
Entity Type:Individual
Prefix:DR
First Name:ALEX
Middle Name:JEAN
Last Name:CULBERSON
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:DR
Other - First Name:ALEX
Other - Middle Name:JEAN
Other - Last Name:TANKERSLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:AUD
Mailing Address - Street 1:600 PROFESSIONAL DR STE 120
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30046-7638
Mailing Address - Country:US
Mailing Address - Phone:678-347-2123
Mailing Address - Fax:
Practice Address - Street 1:600 PROFESSIONAL DR STE 120
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30046-7638
Practice Address - Country:US
Practice Address - Phone:678-347-2123
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-31
Last Update Date:2022-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAUD004323231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist