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General NPI Number Information
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NPI Number | 1891432191
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Entity Type | Organization
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Legal Business Name | SOUTHSIDE READING TUTOR
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Dates
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Enumeration Date | 05/18/2022
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Last Update Date | 05/18/2022
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Provider Practice Location Address
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Address Line | 211 PRIME PT STE D
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City | PEACHTREE CITY
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State | GA
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Zip | 30269-3334
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Country | US
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Telephone | 678-571-1099
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Fax |
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Provider Business Mailing Address
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Address Line | 321 N PEACHTREE PKWY
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City | PEACHTREE CITY
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State | GA
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Zip | 30269-1361
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Country | US
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Telephone | 678-571-1099
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Fax |
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Authorized Official
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Title or Position | PRACTICE MANAGER
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Name | ELIZABETH MCCLEERY
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Credential |
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Telephone | 678-571-1099
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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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