Provider Demographics
NPI:1295028801
Name:LANGHORNE, SHEREDIA D
Entity Type:Individual
Prefix:MS
First Name:SHEREDIA
Middle Name:D
Last Name:LANGHORNE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6930 COTTONWOOD TRL
Mailing Address - Street 2:
Mailing Address - City:RIVERDALE
Mailing Address - State:GA
Mailing Address - Zip Code:30296-2229
Mailing Address - Country:US
Mailing Address - Phone:770-997-8250
Mailing Address - Fax:
Practice Address - Street 1:6930 COTTONWOOD TRL
Practice Address - Street 2:
Practice Address - City:RIVERDALE
Practice Address - State:GA
Practice Address - Zip Code:30296-2229
Practice Address - Country:US
Practice Address - Phone:770-997-8250
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-16
Last Update Date:2011-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP007543235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist