Provider Demographics
NPI:1699758706
Name:HANCOCK, KAY WEAVER (MED, CCC-SLP)
Entity type:Individual
Prefix:
First Name:KAY
Middle Name:WEAVER
Last Name:HANCOCK
Suffix:
Gender:F
Credentials:MED, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4550 ARKWRIGHT RD
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31210-1302
Mailing Address - Country:US
Mailing Address - Phone:478-477-0601
Mailing Address - Fax:478-477-0133
Practice Address - Street 1:4550 ARKWRIGHT RD
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31210-1302
Practice Address - Country:US
Practice Address - Phone:478-477-0601
Practice Address - Fax:478-477-0133
Is Sole Proprietor?:No
Enumeration Date:2005-11-22
Last Update Date:2021-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
235Z00000X
GA005800235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA106947951DMedicaid