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NPI Code Detail

MEDICARE: THE SPEECH & SWALLOWING CLINIC, LLC

MEDICARE: THE SPEECH & SWALLOWING CLINIC, LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1261QH0700XHearing and Speech Clinic/Center004462GA

General Provider Information

NPI Number : 1306026497
Entity Type Code : Organization
Provider Name (Legal Business Name) : THE SPEECH & SWALLOWING CLINIC, LLC
Provider Business Mailing Address
First Line : 118 PEARL AVE N
Second Line :
City : DOUGLAS
State : GA
Zip : 31533-4632
Country : US
Telephone Number : 912-331-0846
Fax Number : 678-792-4894
Provider Business Practice Location Address
First Line : 618 BOWENS MILL RD SW
Second Line :
City : DOUGLAS
State : GA
Zip : 31533-3926
Country : US
Telephone Number : 912-331-0846
Fax Number : 678-792-4894
Authorized Official
Title or Position : CREDENTIALING SPECIALIST
Name : MRS. MISTY BROWN
Credential :
Telephone Number : 912-331-0846
Provider Enumeration Date : 11/06/2007
Last Update Date : 09/11/2025

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