Provider Demographics
NPI:1982177754
Name:SILLS, DEBORAH (M ED)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:
Last Name:SILLS
Suffix:
Gender:F
Credentials:M ED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1323 PRESTON RD
Mailing Address - Street 2:
Mailing Address - City:CATAULA
Mailing Address - State:GA
Mailing Address - Zip Code:31804-3018
Mailing Address - Country:US
Mailing Address - Phone:706-566-2836
Mailing Address - Fax:
Practice Address - Street 1:6079 KNOLOGY WAY
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31909-4963
Practice Address - Country:US
Practice Address - Phone:706-507-4433
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-04
Last Update Date:2019-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP010424235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist