Provider Demographics
NPI:1750909578
Name:SOUTHERN HOPE THERAPY ASSOCIATES LLC
Entity type:Organization
Organization Name:SOUTHERN HOPE THERAPY ASSOCIATES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH LANGUAGE PATHOLOGIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:KRISTIN
Authorized Official - Middle Name:J
Authorized Official - Last Name:FRYMAN
Authorized Official - Suffix:
Authorized Official - Credentials:CCC-SLP
Authorized Official - Phone:757-575-9905
Mailing Address - Street 1:3651 MARS HILL RD STE 2900
Mailing Address - Street 2:
Mailing Address - City:WATKINSVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30677-5985
Mailing Address - Country:US
Mailing Address - Phone:706-389-0748
Mailing Address - Fax:
Practice Address - Street 1:3651 MARS HILL RD STE 2900
Practice Address - Street 2:
Practice Address - City:WATKINSVILLE
Practice Address - State:GA
Practice Address - Zip Code:30677-5985
Practice Address - Country:US
Practice Address - Phone:706-389-0748
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-08
Last Update Date:2020-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty