Healthcare Provider Details

I. General information

NPI: 1851654974
Provider Name (Legal Business Name): WE CARE DEVELOPMENTAL MILESTONES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/22/2012
Last Update Date: 06/22/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5205 VILLAGE CT
UNION CITY GA
30291-5146
US

IV. Provider business mailing address

5205 VILLAGE CT
UNION CITY GA
30291-5146
US

V. Phone/Fax

Practice location:
  • Phone: 404-432-0377
  • Fax: 770-969-6319
Mailing address:
  • Phone: 404-432-0377
  • Fax: 770-969-6319

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code302F00000X
TaxonomyExclusive Provider Organization
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code251300000X
TaxonomyLocal Education Agency (LEA)
License Number
License Number StateNULL

VIII. Authorized Official

Name: MRS. PRISCILLA D JOHNSON-MUSA
Title or Position: SI/COORDINATOR
Credential: LCSW/E.I. SPECIALIST
Phone: 404-432-0377