Provider Demographics
NPI:1528723863
Name:SOUTH ATLANTIC SPEECH, PLLC
Entity type:Organization
Organization Name:SOUTH ATLANTIC SPEECH, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH LANGUAGE PATHOLOGIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MATTIE
Authorized Official - Middle Name:
Authorized Official - Last Name:RATLIFF
Authorized Official - Suffix:
Authorized Official - Credentials:MS,CCC-SLP
Authorized Official - Phone:276-730-4263
Mailing Address - Street 1:7981 SUMTER RIDGE LN APT 3205
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27617-6725
Mailing Address - Country:US
Mailing Address - Phone:276-730-4363
Mailing Address - Fax:
Practice Address - Street 1:7981 SUMTER RIDGE LN APT 3205
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27617-6725
Practice Address - Country:US
Practice Address - Phone:276-730-4363
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-02
Last Update Date:2022-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty