Healthcare Provider Details

I. General information

NPI: 1528171535
Provider Name (Legal Business Name): COBBLESTONE PATHWAYS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/16/2006
Last Update Date: 08/07/2026
Certification Date: 08/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12060 ETRIS RD STE F100
ROSWELL GA
30075-1470
US

IV. Provider business mailing address

12010 ETRIS RD SUITE A-150
ROSWELL GA
30075-1421
US

V. Phone/Fax

Practice location:
  • Phone: 770-998-9599
  • Fax: 770-645-1313
Mailing address:
  • Phone: 770-998-9599
  • Fax: 770-645-1313

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: MRS. HEATHER REBECCA TAYLOR
Title or Position: OWNER- SLP
Credential: M.A. CCC-SLP
Phone: 770-998-9599