Provider Demographics
NPI:1679601967
Name:WOOLLEY, SARA MARTIN (AUD)
Entity type:Individual
Prefix:DR
First Name:SARA
Middle Name:MARTIN
Last Name:WOOLLEY
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4671 BENTLEY PL
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:GA
Mailing Address - Zip Code:30096-6128
Mailing Address - Country:US
Mailing Address - Phone:770-840-0965
Mailing Address - Fax:770-476-0053
Practice Address - Street 1:6600 SUGARLOAF PKWY
Practice Address - Street 2:SUITE 800
Practice Address - City:DULUTH
Practice Address - State:GA
Practice Address - Zip Code:30097-4344
Practice Address - Country:US
Practice Address - Phone:770-476-3005
Practice Address - Fax:770-476-0053
Is Sole Proprietor?:No
Enumeration Date:2007-03-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA3517231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA64BCBPHMedicare ID - Type Unspecified