| NPI | 1184862856 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DEDRA SHERISE BRADHAM Owner/Agent 678-591-6524 |
| Organization Subpart ? | No |
| Primary Taxonomy | 252Y00000X Early Intervention Provider Agency (Licence: GA SLP006318) |
| Additional Taxonomies | 251E00000X Home Health (Licence: GA SLP006318) |
| Enumeration Date | 2009-02-03 |
| Last Update Date | 2009-02-03 |