Provider Demographics
NPI:1316782550
Name:MCCURLEY, ANNA GRACE (CCC-SLP)
Entity type:Individual
Prefix:
First Name:ANNA
Middle Name:GRACE
Last Name:MCCURLEY
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:653 EAGLE GROVE SCHOOL RD
Mailing Address - Street 2:
Mailing Address - City:CANON
Mailing Address - State:GA
Mailing Address - Zip Code:30520-4607
Mailing Address - Country:US
Mailing Address - Phone:706-371-1526
Mailing Address - Fax:
Practice Address - Street 1:323 FRANKLIN SPRINGS ST
Practice Address - Street 2:
Practice Address - City:ROYSTON
Practice Address - State:GA
Practice Address - Zip Code:30662-4014
Practice Address - Country:US
Practice Address - Phone:706-981-9314
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-28
Last Update Date:2024-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP013095235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist