Healthcare Provider Details

I. General information

NPI: 1437541836
Provider Name (Legal Business Name): BRIGHTER VOICES SPEECH AND LANGUAGE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/23/2015
Last Update Date: 03/12/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

113 DERBY DR
RIVERDALE GA
30274-6717
US

IV. Provider business mailing address

113 DERBY DR
RIVERDALE GA
30274-6717
US

V. Phone/Fax

Practice location:
  • Phone: 770-827-0875
  • Fax: 678-489-7263
Mailing address:
  • Phone: 770-827-0875
  • Fax: 678-489-7263

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number10603
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: TUSHANNA PURDIE COLE
Title or Position: CEO
Credential:
Phone: 770-827-0875