Provider Demographics
NPI:1548757560
Name:SWALLOWING SPECIALISTS OF CENTRAL GEORGIA, LLC
Entity Type:Organization
Organization Name:SWALLOWING SPECIALISTS OF CENTRAL GEORGIA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TAMATHA
Authorized Official - Middle Name:
Authorized Official - Last Name:RUTHERFORD
Authorized Official - Suffix:
Authorized Official - Credentials:MCD,CCC/SLP/MDTP/MBS
Authorized Official - Phone:478-334-2328
Mailing Address - Street 1:610 3RD ST STE 200
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31201-3262
Mailing Address - Country:US
Mailing Address - Phone:478-334-2328
Mailing Address - Fax:478-216-9186
Practice Address - Street 1:610 3RD ST STE 200
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31201-3262
Practice Address - Country:US
Practice Address - Phone:478-334-2328
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-16
Last Update Date:2022-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty