Provider Demographics
NPI:1326599747
Name:ALFORD, DEEDRA (AUD)
Entity Type:Individual
Prefix:
First Name:DEEDRA
Middle Name:
Last Name:ALFORD
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 VENUE WAY
Mailing Address - Street 2:APT 9301
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30005-4563
Mailing Address - Country:US
Mailing Address - Phone:309-287-3767
Mailing Address - Fax:
Practice Address - Street 1:5455 MERIDIAN MARKS RD
Practice Address - Street 2:SUITE 130
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30342-1654
Practice Address - Country:US
Practice Address - Phone:404-591-1884
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-20
Last Update Date:2016-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAUD004046231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist