Provider Demographics
NPI:1407598949
Name:CANTRELL, COURTNEY SUMMER (HADS001059)
Entity Type:Individual
Prefix:MRS
First Name:COURTNEY
Middle Name:SUMMER
Last Name:CANTRELL
Suffix:
Gender:F
Credentials:HADS001059
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 STEVEN B TANGER BLVD STE 307
Mailing Address - Street 2:
Mailing Address - City:COMMERCE
Mailing Address - State:GA
Mailing Address - Zip Code:30529-3554
Mailing Address - Country:US
Mailing Address - Phone:678-478-7440
Mailing Address - Fax:
Practice Address - Street 1:800 STEVEN B TANGER BLVD STE 307
Practice Address - Street 2:
Practice Address - City:COMMERCE
Practice Address - State:GA
Practice Address - Zip Code:30529-3554
Practice Address - Country:US
Practice Address - Phone:678-478-7440
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-13
Last Update Date:2022-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAHADE035385237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist