Healthcare Provider Details

I. General information

NPI: 1912836313
Provider Name (Legal Business Name): SOPHIA GUZMAN-ROMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/14/2026
Last Update Date: 05/14/2026
Certification Date: 05/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

502 WHEAT AVE
BAINBRIDGE GA
39819-4325
US

IV. Provider business mailing address

502 WHEAT AVE
BAINBRIDGE GA
39819-4325
US

V. Phone/Fax

Practice location:
  • Phone: 229-246-4088
  • Fax: 229-246-0205
Mailing address:
  • Phone: 229-246-4088
  • Fax: 229-246-0205

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSLP014099
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: