Provider Demographics
NPI:1912429010
Name:SOUTHERN SPEECH PATHOLOGY SERVICES, LLC
Entity Type:Organization
Organization Name:SOUTHERN SPEECH PATHOLOGY SERVICES, LLC
Other - Org Name:HOLLY MCDONALD HOWARD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SOLE PROPRIETER
Authorized Official - Prefix:
Authorized Official - First Name:HOLLY
Authorized Official - Middle Name:MCDONALD
Authorized Official - Last Name:HOWARD
Authorized Official - Suffix:
Authorized Official - Credentials:MED, CCC-SLP
Authorized Official - Phone:478-595-0317
Mailing Address - Street 1:2035 REBIE RD
Mailing Address - Street 2:
Mailing Address - City:DUDLEY
Mailing Address - State:GA
Mailing Address - Zip Code:31022-2411
Mailing Address - Country:US
Mailing Address - Phone:478-595-0317
Mailing Address - Fax:000-000-0000
Practice Address - Street 1:2035 REBIE RD
Practice Address - Street 2:
Practice Address - City:DUDLEY
Practice Address - State:GA
Practice Address - Zip Code:31022-2411
Practice Address - Country:US
Practice Address - Phone:478-595-0317
Practice Address - Fax:000-000-0000
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-10
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP005385235Z00000X
261QM1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty