Provider Demographics
NPI:1710584685
Name:PAULA L SUMPLE, MS CCC-SLP LLC
Entity Type:Organization
Organization Name:PAULA L SUMPLE, MS CCC-SLP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, SLP
Authorized Official - Prefix:
Authorized Official - First Name:PAULA
Authorized Official - Middle Name:
Authorized Official - Last Name:SUMPLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-374-7956
Mailing Address - Street 1:1836 CONDOR DR NE
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30066-1264
Mailing Address - Country:US
Mailing Address - Phone:404-374-7956
Mailing Address - Fax:706-553-8195
Practice Address - Street 1:1836 CONDOR DR NE
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30066-1264
Practice Address - Country:US
Practice Address - Phone:404-374-7956
Practice Address - Fax:706-553-8195
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-05
Last Update Date:2020-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0700XAmbulatory Health Care FacilitiesClinic/CenterHearing and Speech
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000806132DMedicaid