Provider Demographics
NPI:1639741374
Name:SUTHERLAND, CHARI C (SLP)
Entity type:Individual
Prefix:
First Name:CHARI
Middle Name:C
Last Name:SUTHERLAND
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 1:1880 BRASELTON HWY STE 118
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30043-2877
Mailing Address - Country:US
Mailing Address - Phone:470-306-4501
Mailing Address - Fax:678-254-1778
Practice Address - Street 1:1880 BRASELTON HWY STE 118
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30043-2877
Practice Address - Country:US
Practice Address - Phone:470-306-4501
Practice Address - Fax:888-919-2796
Is Sole Proprietor?:No
Enumeration Date:2021-07-13
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP002099235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist