Provider Demographics
NPI:1447784210
Name:SHULAR, ALEXANDRA
Entity Type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:
Last Name:SHULAR
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 1:35 MOSBY WOODS DR
Mailing Address - Street 2:
Mailing Address - City:NEWNAN
Mailing Address - State:GA
Mailing Address - Zip Code:30265-2292
Mailing Address - Country:US
Mailing Address - Phone:678-326-9355
Mailing Address - Fax:
Practice Address - Street 1:2759 MOUNT ZION PKWY
Practice Address - Street 2:SUITE A
Practice Address - City:JONESBORO
Practice Address - State:GA
Practice Address - Zip Code:30236-2568
Practice Address - Country:US
Practice Address - Phone:770-703-3796
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-18
Last Update Date:2017-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP009529235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist