Provider Demographics
NPI:1235281247
Name:THAMES, SHERRIE (SLP)
Entity Type:Individual
Prefix:MRS
First Name:SHERRIE
Middle Name:
Last Name:THAMES
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1705 DALTON DRIVE
Mailing Address - Street 2:
Mailing Address - City:LOCUST GROVE
Mailing Address - State:GA
Mailing Address - Zip Code:30248
Mailing Address - Country:US
Mailing Address - Phone:770-385-0205
Mailing Address - Fax:770-385-0289
Practice Address - Street 1:1705 DALTON DR
Practice Address - Street 2:
Practice Address - City:LOCUST GROVE
Practice Address - State:GA
Practice Address - Zip Code:30248-2476
Practice Address - Country:US
Practice Address - Phone:770-385-0205
Practice Address - Fax:770-385-0289
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-18
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP005050235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist