MEDICARE: SOUTHERN SPEECH THERAPY

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
1	235Z00000X	Speech-Language Pathologist

General Provider Information

NPI Number	:	1841142775
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUTHERN SPEECH THERAPY

Provider Business Mailing Address
First Line	:	5425 W HIGHWAY 166
Second Line	:
City	:	CARROLLTON
State	:	GA
Zip	:	30117
Country	:	US
Telephone Number	:	678-274-7392
Fax Number	:

Provider Business Practice Location Address
First Line	:	5425 W HIGHWAY 166
Second Line	:
City	:	CARROLLTON
State	:	GA
Zip	:	30117
Country	:	US
Telephone Number	:	678-274-7392
Fax Number	:

Authorized Official
Title or Position	:	SPEECH LANGUAGE PATHOLOGIST
Name	:	KERI FAISON
Credential	:	M.ED., CCC-SLP
Telephone Number	:	678-274-7392

Provider Enumeration Date	:	02/12/2026
Last Update Date	:	02/12/2026

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Directions to “SOUTHERN SPEECH THERAPY ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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