Organization
GREAT START DEVELOPMENT CENTER, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SAMANTHA GRAY MILLER (OWNER/ADMINISTRATOR)
(770) 713-6486
Entity
Organization
Contact information
Practice address
975 COBB PLACE BLVD NW STE 101, KENNESAW, GA 30144-6848
(770) 713-6486
Mailing address
975 COBB PLACE BLVD NW STE 101, KENNESAW, GA 30144-6848
Taxonomy
Speciality
Code
Description
License number
State
252Y00000X
Early Intervention Provider Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
252Y00000X
PROVIDER FOR BABIES CAN'T WAIT
—
Enumeration date
10/30/2018
Last updated
10/30/2018
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