| NPI | 1922798495 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KUANTARA SHORELL INGRAM Owner, Speech Language Pathologist 678-215-2554 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM1300X Clinic/Center, Multi-Specialty |
| Additional Taxonomies | 224Z00000X Occupational Therapy Assistant |
| 225100000X Physical Therapist | |
| 225X00000X Occupational Therapist | |
| 235Z00000X Speech-Language Pathologist, | |
| 261QH0100X Clinic/Center, Health Services | |
| 343900000X Non-emergency Medical Transport (VAN) | |
| 347C00000X Private Vehicle | |
| Enumeration Date | 2023-05-09 |
| Last Update Date | 2023-05-09 |