Provider Demographics
NPI:1205994001
Name:ALFORD, FELICIA JANEL (MACCC-SLP)
Entity type:Individual
Prefix:MS
First Name:FELICIA
Middle Name:JANEL
Last Name:ALFORD
Suffix:
Gender:F
Credentials:MACCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1562 RICE SQ
Mailing Address - Street 2:
Mailing Address - City:LITHONIA
Mailing Address - State:GA
Mailing Address - Zip Code:30058-3253
Mailing Address - Country:US
Mailing Address - Phone:678-526-2760
Mailing Address - Fax:
Practice Address - Street 1:1562 RICE SQ
Practice Address - Street 2:
Practice Address - City:LITHONIA
Practice Address - State:GA
Practice Address - Zip Code:30058-3253
Practice Address - Country:US
Practice Address - Phone:678-526-2760
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-05
Last Update Date:2009-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP006240235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA890670308AMedicaid