Individual
RALPH SMITH DELOACH III
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.ED.,CCC-SLP
Contact information
Practice address
3615 BRASELTON HWY, SUITE 103, DACULA, GA 30019-5906
(678) 377-9634
(678) 377-9609
Mailing address
3615 BRASELTON HWY, SUITE 103, DACULA, GA 30019-5906
(678) 377-9634
(678) 377-9609
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
SLP004677
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
10035715
—
GA
05
—
305500
—
GA
01
—
52813029-001
BCBS PROVIDER ID
GA
Enumeration date
11/28/2006
Last updated
04/07/2020
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