Healthcare Provider Details

I. General information

NPI: 1386708154
Provider Name (Legal Business Name): SPEECH HEARING AND REHABILITATION ENTERPRISES OF COASTAL GEORGIA INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/19/2006
Last Update Date: 07/29/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2228 STARLING ST
BRUNSWICK GA
31520-4200
US

IV. Provider business mailing address

2228 STARLING ST
BRUNSWICK GA
31520-4200
US

V. Phone/Fax

Practice location:
  • Phone: 912-264-3141
  • Fax: 912-264-6190
Mailing address:
  • Phone: 912-264-3141
  • Fax: 912-264-6190

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT008488
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSLP001913
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSLP002066
License Number StateGA

VIII. Authorized Official

Name: CHERYL MEADOWS USSERY
Title or Position: EXECUTIVE DIRECOTR
Credential:
Phone: 912-264-3141