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General NPI Number Information
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NPI Number | 1902453871
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Entity Type | Organization
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Legal Business Name | CSJKIDS, LLC
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Dates
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Enumeration Date | 08/24/2019
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Last Update Date | 08/24/2019
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Provider Practice Location Address
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Address Line | 166 CYPRESS COVE CT
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City | GRAYSON
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State | GA
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Zip | 30017-4199
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Country | US
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Telephone | 770-896-7948
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Fax | 770-837-0855
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Provider Business Mailing Address
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Address Line | 166 CYPRESS COVE CT
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City | GRAYSON
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State | GA
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Zip | 30017-4199
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Country | US
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Telephone | 770-896-7948
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Fax | 770-837-0855
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Authorized Official
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Title or Position | OWNER
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Name | JONATHON W PATTON
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Credential |
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Telephone | 770-896-7948
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number |
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License Number State |
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