Raleeta Dianne Davis, MEDCCCSLP

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

SLP005154 Issued in GA

Practice address

136 Marshs Edge LN
St Simons Is, GA 31522-8898

Phone

(912) 291-2029

NPI assigned

Feb 8, 2018

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1518048000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1518048000000",
    "number": "1134628795",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "136 MARSHS EDGE LN",
            "city": "ST SIMONS IS",
            "state": "GA",
            "postal_code": "315228898",
            "telephone_number": "912-291-2029"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "136 MARSHS EDGE LN",
            "city": "ST SIMONS IS",
            "state": "GA",
            "postal_code": "315228898",
            "telephone_number": "912-291-2029"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DAVIS",
        "first_name": "RALEETA",
        "middle_name": "DIANNE",
        "credential": "MEDCCCSLP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2018-02-08",
        "last_updated": "2018-02-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "GA",
            "license": "SLP005154",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kristen Agurs, MPT
• Aaron Allen
• Alphacare Christian Therapy
• Julia Anne Casey, DPT
• Dental Center of St Simons
• Hunter Farthing, MS, RDN, LDN
• Ronald Tracy Gerken, RPH
• Matthew Mackinnon Gibbs
• Gail Katherine Godwin, PHD, PMHNP-BC

• All providers in St Simons Is, GA
• Speech-Language Pathologist in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 8, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.