Provider Demographics
NPI:1861030157
Name:SOUTH GEORGIA THERAPY CENTER
Entity Type:Organization
Organization Name:SOUTH GEORGIA THERAPY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LINDSAY
Authorized Official - Middle Name:M
Authorized Official - Last Name:HUTCHESON
Authorized Official - Suffix:
Authorized Official - Credentials:MED CCC-SLP
Authorized Official - Phone:912-501-4047
Mailing Address - Street 1:515 PETERSON AVE S STE B
Mailing Address - Street 2:
Mailing Address - City:DOUGLAS
Mailing Address - State:GA
Mailing Address - Zip Code:31533-5244
Mailing Address - Country:US
Mailing Address - Phone:912-381-3444
Mailing Address - Fax:
Practice Address - Street 1:515 PETERSON AVE S STE B
Practice Address - Street 2:
Practice Address - City:DOUGLAS
Practice Address - State:GA
Practice Address - Zip Code:31533-5244
Practice Address - Country:US
Practice Address - Phone:912-501-4047
Practice Address - Fax:912-501-5289
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-17
Last Update Date:2020-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty