Provider Demographics
NPI:1053721506
Name:DOBBS, SHERRIDON (MS, CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:SHERRIDON
Middle Name:
Last Name:DOBBS
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:311 COOPER RD
Mailing Address - Street 2:
Mailing Address - City:LOGANVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30052-4976
Mailing Address - Country:US
Mailing Address - Phone:678-205-5437
Mailing Address - Fax:678-377-7950
Practice Address - Street 1:311 COOPER RD
Practice Address - Street 2:
Practice Address - City:LOGANVILLE
Practice Address - State:GA
Practice Address - Zip Code:30052-4976
Practice Address - Country:US
Practice Address - Phone:678-205-5437
Practice Address - Fax:678-377-7950
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-06
Last Update Date:2014-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP 004962235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GASLP 004962OtherSTATE LICENSE