Provider Demographics
NPI:1255517967
Name:DAUGHTRY, SUSAN CARREKER (MCD,CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:CARREKER
Last Name:DAUGHTRY
Suffix:
Gender:F
Credentials:MCD,CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 TAMIE CT
Mailing Address - Street 2:
Mailing Address - City:KATHLEEN
Mailing Address - State:GA
Mailing Address - Zip Code:31047-2222
Mailing Address - Country:US
Mailing Address - Phone:478-397-7886
Mailing Address - Fax:478-218-2715
Practice Address - Street 1:105 TAMIE CT
Practice Address - Street 2:
Practice Address - City:KATHLEEN
Practice Address - State:GA
Practice Address - Zip Code:31047-2222
Practice Address - Country:US
Practice Address - Phone:478-397-7886
Practice Address - Fax:478-218-2715
Is Sole Proprietor?:No
Enumeration Date:2008-01-11
Last Update Date:2008-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP001471235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist