Provider Demographics
NPI:1316143274
Name:HUNT, NANCY MAMIE (SLP)
Entity type:Individual
Prefix:MRS
First Name:NANCY
Middle Name:MAMIE
Last Name:HUNT
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2902 GALAHAD WAY
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30909-9146
Mailing Address - Country:US
Mailing Address - Phone:706-877-2718
Mailing Address - Fax:706-608-9049
Practice Address - Street 1:2485 HIGHWAY 88
Practice Address - Street 2:
Practice Address - City:HEPHZIBAH
Practice Address - State:GA
Practice Address - Zip Code:30815-4691
Practice Address - Country:US
Practice Address - Phone:706-592-5565
Practice Address - Fax:706-608-9049
Is Sole Proprietor?:No
Enumeration Date:2007-06-26
Last Update Date:2021-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP006667235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA525789197AMedicaid