Healthcare Provider Details

I. General information

NPI: 1225807464
Provider Name (Legal Business Name): SOLID FOUNDATION LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/29/2023
Last Update Date: 12/29/2023
Certification Date: 12/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

613 STREAM CT
FAIRBURN GA
30213-5820
US

IV. Provider business mailing address

1040 GENNY LN
RIVERDALE GA
30296-2710
US

V. Phone/Fax

Practice location:
  • Phone: 404-457-2245
  • Fax:
Mailing address:
  • Phone: 404-457-2245
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: MS. DEMETRES THOMAS
Title or Position: OWNER
Credential:
Phone: 404-457-2245