Provider Demographics
NPI:1801145339
Name:FENTON, CYNTHIA L (AUD)
Entity type:Individual
Prefix:DR
First Name:CYNTHIA
Middle Name:L
Last Name:FENTON
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:CYNTHIA
Other - Middle Name:L
Other - Last Name:DURHAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:AUD
Mailing Address - Street 1:3160 NORTHSIDE PKWY NW
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30327
Mailing Address - Country:US
Mailing Address - Phone:404-233-5332
Mailing Address - Fax:404-266-2175
Practice Address - Street 1:3160 NORTHSIDE PKWY NW
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30327
Practice Address - Country:US
Practice Address - Phone:404-233-5332
Practice Address - Fax:404-266-2175
Is Sole Proprietor?:No
Enumeration Date:2012-08-30
Last Update Date:2012-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAUD003781231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist