Provider Demographics
NPI:1730619263
Name:SOVEREIGN THERAPY CENTER, LLC
Entity type:Organization
Organization Name:SOVEREIGN THERAPY CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH LANGUAGE PATHOLOGIST/CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:APRIL
Authorized Official - Middle Name:A
Authorized Official - Last Name:MCRAE
Authorized Official - Suffix:
Authorized Official - Credentials:SLPD,CCC-SLP
Authorized Official - Phone:678-421-4351
Mailing Address - Street 1:925 PEACHTREE ST NE STE B-509
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30309-3918
Mailing Address - Country:US
Mailing Address - Phone:678-421-4351
Mailing Address - Fax:
Practice Address - Street 1:3867 HOLCOMB BRIDGE RD STE 400
Practice Address - Street 2:
Practice Address - City:PEACHTREE CORNERS
Practice Address - State:GA
Practice Address - Zip Code:30092-2232
Practice Address - Country:US
Practice Address - Phone:678-421-4351
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-18
Last Update Date:2017-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA225X00000X, 103TC2200X, 2081P0010X, 222Q00000X, 235Z00000X
GASLP006498235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & AdolescentGroup - Multi-Specialty
No2081P0010XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPediatric Rehabilitation MedicineGroup - Multi-Specialty
No222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental TherapistGroup - Multi-Specialty