Organization
SELF-INVESTMENT ENRICHMENT SERVICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ADRIA NICOLE WIGGINS (DIRECTOR)
(678) 833-1812
Entity
Organization
Contact information
Practice address
2020 AVALON PKWY, SUITE 165, MCDONOUGH, GA 30253-3087
(678) 833-1812
(678) 833-1825
Mailing address
2020 AVALON PKWY, SUITE 165, MCDONOUGH, GA 30253-3087
(678) 833-1812
(678) 833-1825
Taxonomy
Speciality
Code
Description
License number
State
251C00000X
Developmentally Disabled Services Day Training Agency
—
—
251E00000X
Home Health Agency
Primary
—
—
Other
Enumeration date
01/12/2012
Last updated
09/26/2014
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