Provider Demographics
NPI:1972397883
Name:SCARBOROUGH, LOGAN GEORGE
Entity type:Individual
Prefix:
First Name:LOGAN
Middle Name:GEORGE
Last Name:SCARBOROUGH
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3831 FERN BANK RD
Mailing Address - Street 2:
Mailing Address - City:VALDOSTA
Mailing Address - State:GA
Mailing Address - Zip Code:31601-2730
Mailing Address - Country:US
Mailing Address - Phone:229-412-7223
Mailing Address - Fax:
Practice Address - Street 1:3831 FERN BANK RD
Practice Address - Street 2:
Practice Address - City:VALDOSTA
Practice Address - State:GA
Practice Address - Zip Code:31601-2730
Practice Address - Country:US
Practice Address - Phone:229-412-7223
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-07
Last Update Date:2025-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA14491536235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist