Provider Demographics
NPI:1356737811
Name:COX, GINA (MED, CCC/SLP)
Entity type:Individual
Prefix:
First Name:GINA
Middle Name:
Last Name:COX
Suffix:
Gender:F
Credentials:MED, CCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1749 RED HILL RD
Mailing Address - Street 2:
Mailing Address - City:RICHLAND
Mailing Address - State:GA
Mailing Address - Zip Code:31825-7539
Mailing Address - Country:US
Mailing Address - Phone:706-575-0526
Mailing Address - Fax:
Practice Address - Street 1:4350 WARM SPRINGS RD STE 500
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31909-5986
Practice Address - Country:US
Practice Address - Phone:706-575-0526
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-11
Last Update Date:2015-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP003295235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist