Provider Demographics
NPI:1598930265
Name:MAXWELL, EMMA (MA, FAAA)
Entity Type:Individual
Prefix:MRS
First Name:EMMA
Middle Name:
Last Name:MAXWELL
Suffix:
Gender:F
Credentials:MA, FAAA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:61 HAYWOOD PARK DRIVE SUITE B
Mailing Address - Street 2:
Mailing Address - City:CLYDE
Mailing Address - State:NC
Mailing Address - Zip Code:28721
Mailing Address - Country:US
Mailing Address - Phone:678-642-6421
Mailing Address - Fax:
Practice Address - Street 1:61 HAYWOOD PARK DRIVE
Practice Address - Street 2:
Practice Address - City:CLYDE
Practice Address - State:NC
Practice Address - Zip Code:28721-7212
Practice Address - Country:US
Practice Address - Phone:828-627-1950
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-04-24
Last Update Date:2017-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAUD003759231H00000X
NC12538231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist