Healthcare Provider Details

I. General information

NPI: 1700075124
Provider Name (Legal Business Name): ADVANCE FOR KIDS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/22/2007
Last Update Date: 03/04/2025
Certification Date: 03/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

70 LINDSEY LN
SAINT MARYS GA
31558-1635
US

IV. Provider business mailing address

PO BOX 5610
SAINT MARYS GA
31558-5610
US

V. Phone/Fax

Practice location:
  • Phone: 912-510-6104
  • Fax: 912-882-6137
Mailing address:
  • Phone: 912-510-6104
  • Fax: 912-882-6137

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: SARAH JOHNSEN
Title or Position: OWNER
Credential: PT
Phone: 912-510-6104