Provider Demographics
NPI:1043787393
Name:BOMAR, SARAH (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:
Last Name:BOMAR
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:235 LACHAIZE CIR
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30327-4346
Mailing Address - Country:US
Mailing Address - Phone:575-636-3461
Mailing Address - Fax:
Practice Address - Street 1:1475 HOLCOMB BRIDGE RD STE 113
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30076-2126
Practice Address - Country:US
Practice Address - Phone:678-591-3542
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-25
Last Update Date:2020-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP010168235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist