Provider Demographics
NPI:1245631563
Name:MAYFIELD, ABBEY
Entity type:Individual
Prefix:
First Name:ABBEY
Middle Name:
Last Name:MAYFIELD
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 1:1303 DANTIGNAC ST
Mailing Address - Street 2:SUITE 2100
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30901-2775
Mailing Address - Country:US
Mailing Address - Phone:706-396-0600
Mailing Address - Fax:706-396-0606
Practice Address - Street 1:1303 DANTIGNAC ST
Practice Address - Street 2:SUITE 2100
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30901-2775
Practice Address - Country:US
Practice Address - Phone:706-396-0600
Practice Address - Fax:706-396-0606
Is Sole Proprietor?:No
Enumeration Date:2014-09-05
Last Update Date:2014-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP008203235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist