Healthcare Provider Details

I. General information

NPI: 1124475025
Provider Name (Legal Business Name): SYKES EARLY INTERVENTION SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/20/2016
Last Update Date: 06/19/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

167 GLEN EAGLE WAY
MCDONOUGH GA
30253-4231
US

IV. Provider business mailing address

167 GLEN EAGLE WAY
MCDONOUGH GA
30253-4231
US

V. Phone/Fax

Practice location:
  • Phone: 407-247-2631
  • Fax:
Mailing address:
  • Phone: 407-247-2631
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number State

VIII. Authorized Official

Name: MRS. DIANNA NOBLES SYKES
Title or Position: CEO
Credential:
Phone: 407-247-2631