Provider Demographics
NPI:1235341165
Name:BUFFINGTON, MANDY M (SLP)
Entity Type:Individual
Prefix:MRS
First Name:MANDY
Middle Name:M
Last Name:BUFFINGTON
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 1:11539 PARK WOODS CIR
Mailing Address - Street 2:SUITE 502
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30005-4413
Mailing Address - Country:US
Mailing Address - Phone:678-527-3224
Mailing Address - Fax:678-366-5886
Practice Address - Street 1:11539 PARK WOODS CIR
Practice Address - Street 2:SUITE 502
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30005-4413
Practice Address - Country:US
Practice Address - Phone:678-527-3224
Practice Address - Fax:678-366-5886
Is Sole Proprietor?:No
Enumeration Date:2007-05-04
Last Update Date:2014-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP006528235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA417016176BMedicaid