Provider Demographics
NPI:1376640557
Name:BOARD OF REGENTS OF THE UNIVERSITY SYSTEM OF GEORGIA
Entity Type:Organization
Organization Name:BOARD OF REGENTS OF THE UNIVERSITY SYSTEM OF GEORGIA
Other - Org Name:UGA SPEECH AND HEARING CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CLINIC DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:TERRY
Authorized Official - Middle Name:J
Authorized Official - Last Name:RAGAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-937-4222
Mailing Address - Street 1:110 CARLTON ST
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:GA
Mailing Address - Zip Code:30602-5004
Mailing Address - Country:US
Mailing Address - Phone:706-542-4598
Mailing Address - Fax:706-542-4574
Practice Address - Street 1:110 CARLTON ST. 593 ADERHOLD HALL
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30602-5004
Practice Address - Country:US
Practice Address - Phone:706-542-4598
Practice Address - Fax:706-542-4574
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2021-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000395403AMedicaid