Provider Demographics
NPI:1932599370
Name:DOOLITTLE, CORLYN
Entity type:Individual
Prefix:
First Name:CORLYN
Middle Name:
Last Name:DOOLITTLE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2626 SUMMIT PKWY SW
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30331-9425
Mailing Address - Country:US
Mailing Address - Phone:706-231-4105
Mailing Address - Fax:
Practice Address - Street 1:412 LAKESIDE VILLA DR
Practice Address - Street 2:
Practice Address - City:LOVEJOY
Practice Address - State:GA
Practice Address - Zip Code:30228
Practice Address - Country:US
Practice Address - Phone:706-231-4105
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-23
Last Update Date:2020-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist