Organization
SPEECH PATHOLOGY ASSOCIATES OF SOUTH EAST GEORGIA, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SHANNON S BENNETT CCC-SLP (OWNER)
(912) 449-9923
Entity
Organization
Contact information
Practice address
2976 US HIGHWAY 84, BLACKSHEAR, GA 31516-4601
(912) 807-8255
(912) 807-8256
Mailing address
4493 ARCH TRL, BLACKSHEAR, GA 31516-4210
(912) 807-8255
(912) 807-8255
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
SLP003867
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000731464C
—
GA
Enumeration date
08/17/2006
Last updated
07/29/2009
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