Provider Demographics
NPI:1730585407
Name:DWIGHT, DEBRA (EDD)
Entity type:Individual
Prefix:DR
First Name:DEBRA
Middle Name:
Last Name:DWIGHT
Suffix:
Gender:F
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 ROCKLAND DR
Mailing Address - Street 2:
Mailing Address - City:SHARPSBURG
Mailing Address - State:GA
Mailing Address - Zip Code:30277-2119
Mailing Address - Country:US
Mailing Address - Phone:770-502-1632
Mailing Address - Fax:
Practice Address - Street 1:25 ROCKLAND DR
Practice Address - Street 2:
Practice Address - City:SHARPSBURG
Practice Address - State:GA
Practice Address - Zip Code:30277-2119
Practice Address - Country:US
Practice Address - Phone:770-502-1632
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-07
Last Update Date:2014-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP003372235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist