Provider Demographics
NPI:1043902539
Name:WILBORN, ASIAH LAVONNE
Entity type:Individual
Prefix:
First Name:ASIAH
Middle Name:LAVONNE
Last Name:WILBORN
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 1:1691 COBBLEFIELD CIR
Mailing Address - Street 2:
Mailing Address - City:DACULA
Mailing Address - State:GA
Mailing Address - Zip Code:30019-7682
Mailing Address - Country:US
Mailing Address - Phone:678-349-6151
Mailing Address - Fax:
Practice Address - Street 1:1691 COBBLEFIELD CIR
Practice Address - Street 2:
Practice Address - City:DACULA
Practice Address - State:GA
Practice Address - Zip Code:30019-7682
Practice Address - Country:US
Practice Address - Phone:678-349-6151
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-23
Last Update Date:2025-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
No261QH0700XAmbulatory Health Care FacilitiesClinic/CenterHearing and Speech