1639243926 NPI number — MS. SARA ANN RICH CCC-SLP

Table of content: MS. SARA ANN RICH CCC-SLP (NPI 1639243926)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1639243926 NPI number — MS. SARA ANN RICH CCC-SLP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RICH
Provider First Name:
SARA
Provider Middle Name:
ANN
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
CCC-SLP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
WILLIAMS
Provider Other First Name:
SARA
Provider Other Middle Name:
ANN
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
CCC-SLP
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1639243926
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/19/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3269 BARWICK RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
QUITMAN
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
31643-6031
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
229-560-7292
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3269 BARWICK RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
QUITMAN
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
31643-6031
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
229-263-5676
Provider Business Practice Location Address Fax Number:
229-263-9067
Provider Enumeration Date:
11/20/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 235Z00000X , with the licence number:  SA2421 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 235Z00000X , with the licence number: SLP003307 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)