Provider Demographics
NPI:1396260576
Name:FELTS, ANGELA (SLP)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:
Last Name:FELTS
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 W HANSELL ST
Mailing Address - Street 2:
Mailing Address - City:THOMASVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31792-6650
Mailing Address - Country:US
Mailing Address - Phone:229-584-5782
Mailing Address - Fax:
Practice Address - Street 1:300 W HANSELL ST
Practice Address - Street 2:
Practice Address - City:THOMASVILLE
Practice Address - State:GA
Practice Address - Zip Code:31792-6650
Practice Address - Country:US
Practice Address - Phone:229-584-5782
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-08
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP009811235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GASLP009811OtherSPEECH LANGUAGE PATHOLOGY