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General NPI Number Information
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NPI Number | 1518896497
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Entity Type | Organization
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Legal Business Name | SOUTHEAST GEORGIA MOBILE THERAPY
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Dates
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Enumeration Date | 05/16/2026
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Last Update Date | 05/16/2026
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Provider Practice Location Address
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Address Line | 1218 GOBBLER LN
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City | WAYCROSS
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State | GA
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Zip | 31503-9586
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Country | US
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Telephone | 912-288-6248
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Fax |
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Provider Business Mailing Address
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Address Line | 1218 GOBBLER LN
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City | WAYCROSS
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State | GA
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Zip | 31503-9586
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Country | US
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Telephone | 912-288-6248
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Fax |
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Authorized Official
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Title or Position | OWNER/MANAGER/SLP
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Name | AMY HENDRIX-BENNETT
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Credential | CCC/SLP
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Telephone | 912-288-6248
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number |
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License Number State |
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