Provider Demographics
NPI:1841437829
Name:LUDLOW, SHARON WHEELOCK
Entity type:Individual
Prefix:
First Name:SHARON
Middle Name:WHEELOCK
Last Name:LUDLOW
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 1:2395 WALL ST SE
Mailing Address - Street 2:SUITE 170
Mailing Address - City:CONYERS
Mailing Address - State:GA
Mailing Address - Zip Code:30013-6703
Mailing Address - Country:US
Mailing Address - Phone:678-462-3637
Mailing Address - Fax:
Practice Address - Street 1:2395 WALL ST SE
Practice Address - Street 2:SUITE 170
Practice Address - City:CONYERS
Practice Address - State:GA
Practice Address - Zip Code:30013-6703
Practice Address - Country:US
Practice Address - Phone:678-462-3637
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-01-14
Last Update Date:2016-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP005666235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist