1750444964 NPI number — POSITIVE OUTLOOK, LLP

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1750444964 NPI number — POSITIVE OUTLOOK, LLP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
POSITIVE OUTLOOK, LLP
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
POSITIVE OUTLOOK, INC
Provider Other Organization Name Type Code:
5
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1750444964
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/11/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2451 CUMBERLAND PKWY SE
Provider Second Line Business Mailing Address:
SUITE 3606
Provider Business Mailing Address City Name:
ATLANTA
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30339-6136
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
404-381-4108
Provider Business Mailing Address Fax Number:
404-381-3043

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
696 MOUNT ZION RD
Provider Second Line Business Practice Location Address:
SUITE 3B
Provider Business Practice Location Address City Name:
JONESBORO
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30236-1597
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
404-381-4108
Provider Business Practice Location Address Fax Number:
404-381-3043
Provider Enumeration Date:
12/18/2006

Additional Information

Authorized Official

Authorized Official Last Name:
REESE
Authorized Official First Name:
LAWANDA
Authorized Official Middle Name:
Authorized Official Title or Position:
SPEECH-LANGUAGE PATHOLOGIST
Authorized Official Telephone Number:
404-381-4108

Provider Taxonomy Codes

  • Taxonomy code: 235Z00000X , with the licence number:  SLP005435 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 00972573B , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".




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