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General NPI Number Information
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NPI Number | 1972932028
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Entity Type | Organization
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Legal Business Name | COMMUNITY KIDS PEDIATRIC THERAPY SERVICES
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Dates
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Enumeration Date | 11/08/2013
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Last Update Date | 11/08/2013
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Provider Practice Location Address
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Address Line | 3229 HIGHWAY 34 E STE 103
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City | NEWNAN
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State | GA
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Zip | 30265-2196
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Country | US
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Telephone | 770-502-0303
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Fax |
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Provider Business Mailing Address
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Address Line | 90 GLENDA TRCE STE F #414
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City | NEWNAN
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State | GA
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Zip | 30265-3868
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Country | US
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Telephone | 770-502-0303
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Fax |
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Authorized Official
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Title or Position | SPEECH THERAPIST/OWNER
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Name | MRS. BROOKE LARAYNE BARNES
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Credential | MS CCC-SLP
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Telephone | 770-502-0303
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | SLP006883
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License Number State | GA
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