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Organization
SCINTILLA CHARTER ACADEMY
Active
Organization
SCINTILLA CHARTER ACADEMY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
STEPHANIE HERNDON (OFFICE MANAGER)
(229) 244-5750
Entity
Organization
Contact information
Practice address
2171 E PARK AVE, VALDOSTA, GA 31602-4436
(229) 244-5750
Mailing address
2171 E PARK AVE, VALDOSTA, GA 31602-4436
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
9005
GA
225X00000X
Occupational Therapist
6136
GA
235Z00000X
Speech-Language Pathologist
Primary
1930
GA
Other
Enumeration date
09/10/2015
Last updated
09/10/2015
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