Healthcare Provider Details

I. General information

NPI: 1790695658
Provider Name (Legal Business Name): MOLLY BETH FAISON CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/11/2026
Last Update Date: 09/11/2026
Certification Date: 09/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

56 JERUSALEM CHURCH RD
JASPER GA
30143-3701
US

IV. Provider business mailing address

56 JERUSALEM CHURCH RD
JASPER GA
30143-3701
US

V. Phone/Fax

Practice location:
  • Phone: 334-201-0085
  • Fax:
Mailing address:
  • Phone: 334-201-0085
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: