Provider Demographics
NPI:1184829608
Name:DILWORTH, SARA B (MED)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:B
Last Name:DILWORTH
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3483 SATELLITE BLVD STE 304
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:GA
Mailing Address - Zip Code:30096-8693
Mailing Address - Country:US
Mailing Address - Phone:770-418-1778
Mailing Address - Fax:778-418-1794
Practice Address - Street 1:3483 SATELLITE BLVD STE 304
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:GA
Practice Address - Zip Code:30096-8693
Practice Address - Country:US
Practice Address - Phone:770-418-1778
Practice Address - Fax:778-418-1794
Is Sole Proprietor?:No
Enumeration Date:2007-06-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP006180235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist