Provider Demographics
NPI:1326470188
Name:NORMAN, SALLY
Entity Type:Individual
Prefix:
First Name:SALLY
Middle Name:
Last Name:NORMAN
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 1:794 WILSON RD NW
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30318-1723
Mailing Address - Country:US
Mailing Address - Phone:706-315-9158
Mailing Address - Fax:
Practice Address - Street 1:300 W WIEUCA RD NE STE 200
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30342-3352
Practice Address - Country:US
Practice Address - Phone:404-808-5427
Practice Address - Fax:833-661-9958
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-04
Last Update Date:2020-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP008274235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist