Provider Demographics
NPI:1730526021
Name:ALFORD, KIMBERLY B (CCC-SLP)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:B
Last Name:ALFORD
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 1:3600 E HIGHWAY 166
Mailing Address - Street 2:
Mailing Address - City:CARROLLTON
Mailing Address - State:GA
Mailing Address - Zip Code:30116-7540
Mailing Address - Country:US
Mailing Address - Phone:404-444-6778
Mailing Address - Fax:
Practice Address - Street 1:121 JACKSON ST
Practice Address - Street 2:
Practice Address - City:NEWNAN
Practice Address - State:GA
Practice Address - Zip Code:30263-1572
Practice Address - Country:US
Practice Address - Phone:770-251-5873
Practice Address - Fax:770-304-2201
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-28
Last Update Date:2023-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP003481235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003178358CMedicaid
GA003178358AMedicaid