Provider Demographics
NPI:1780124552
Name:THURMAN, SUSAN ADAMS
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:ADAMS
Last Name:THURMAN
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 1:185 THURMAN RD
Mailing Address - Street 2:
Mailing Address - City:BROXTON
Mailing Address - State:GA
Mailing Address - Zip Code:31519-3713
Mailing Address - Country:US
Mailing Address - Phone:912-359-2268
Mailing Address - Fax:
Practice Address - Street 1:185 THURMAN RD
Practice Address - Street 2:
Practice Address - City:BROXTON
Practice Address - State:GA
Practice Address - Zip Code:31519-3713
Practice Address - Country:US
Practice Address - Phone:912-359-2268
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-27
Last Update Date:2017-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP003751235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist