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General NPI Number Information
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NPI Number | 1609669738
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Entity Type | Organization
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Legal Business Name | SUPER SUPPORTIVE TEACHING FOR ACHIEVING REMARKABLE SUCCESS INC
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Dates
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Enumeration Date | 05/22/2025
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Last Update Date | 05/22/2025
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Provider Practice Location Address
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Address Line | 5230 JOT EM DOWN RD
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City | CUMMING
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State | GA
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Zip | 30041-3406
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Country | US
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Telephone | 678-249-9206
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Fax |
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Provider Business Mailing Address
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Address Line | 4515 WILDBROOKE PKWY
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City | CUMMING
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State | GA
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Zip | 30041-4824
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Country | US
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Telephone | 678-249-9206
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | SRAVANI GUNDA
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Credential |
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Telephone | 678-249-9206
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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