Basic Information
| Provider Information | |||||||||
| NPI: | 1912429010 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SOUTHERN SPEECH PATHOLOGY SERVICES, LLC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | HOLLY MCDONALD HOWARD | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2035 REBIE RD | ||||||||
| Address2: | |||||||||
| City: | DUDLEY | ||||||||
| State: | GA | ||||||||
| PostalCode: | 310222411 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4785950317 | ||||||||
| FaxNumber: | 0000000000 | ||||||||
| Practice Location | |||||||||
| Address1: | 2035 REBIE RD | ||||||||
| Address2: | |||||||||
| City: | DUDLEY | ||||||||
| State: | GA | ||||||||
| PostalCode: | 310222411 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4785950317 | ||||||||
| FaxNumber: | 0000000000 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/10/2017 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| AuthorizedOfficialLastName: | HOWARD | ||||||||
| AuthorizedOfficialFirstName: | HOLLY | ||||||||
| AuthorizedOfficialMiddleName: | MCDONALD | ||||||||
| AuthorizedOfficialTitleorPosition: | SOLE PROPRIETER | ||||||||
| AuthorizedOfficialTelephone: | 4785950317 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | M.ED., CCC-SLP | ||||||||
| NPICertificationDate: | 11/22/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | SLP005385 | GA | N | 193400000X SINGLE SPECIALTY GROUP | Speech, Language and Hearing Service Providers | Speech-Language Pathologist | 261QM1300X | Y | Ambulatory Health Care Facilities | Clinic/Center | Multi-Specialty |
No ID Information.