# VIVID SPARK LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Vivid spark services
- **Organization subpart:** No

## Provider details

- **NPI number:** 1174316350
- **Authorized official:** FARAH S BAIG MD (PART OWNER)
- **Authorized official phone:** (678) 206-6018

## Contact information

- **Practice address:** 1590 ATKINSON RD STE 101, LAWRENCEVILLE, GA 30043-5674
- **Practice address phone:** (678) 206-6018
- **Practice address fax:** (678) 669-2659
- **Mailing address:** 773 BRENTMEAD DR, LAWRENCEVILLE, GA 30044-6077
- **Mailing address phone:** (678) 206-6018
- **Mailing address fax:** (678) 669-2659

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 251E00000X | Home Health Agency | — | NULL | Yes |
| 253Z00000X | In Home Supportive Care Agency | — | NULL | — |

## Other

- **Enumeration date:** 05/28/2025
- **Last updated:** 05/28/2025