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General NPI Number Information
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NPI Number | 1023476496
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Entity Type | Organization
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Legal Business Name | MADEQUEST LLC
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Dates
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Enumeration Date | 02/01/2016
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Last Update Date | 02/22/2016
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Provider Practice Location Address
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Address Line | 3355 LENOX RD NE
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City | ATLANTA
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State | GA
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Zip | 30326-1394
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Country | US
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Telephone | 702-608-6233
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Fax |
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Provider Business Mailing Address
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Address Line | 2894 PORT ROYAL LN
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City | DECATUR
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State | GA
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Zip | 30034-2770
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Country | US
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Telephone | 404-729-2520
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Fax |
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Authorized Official
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Title or Position | NEURO-SPEECH-LANGUAGE PATHOLOGIST
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Name | TOMIKA CHAPPELL
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Credential | M.A. CCC-SLP
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Telephone | 404-729-2520
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251C00000X
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Taxonomy Name | Developmentally Disabled Services Day Training Agency
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License Number | SLP007131
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License Number State | GA
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