Provider Demographics
NPI:1275292302
Name:DIVINE SPEECH AND LANGUAGE SERVICES INC
Entity Type:Organization
Organization Name:DIVINE SPEECH AND LANGUAGE SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHELSE
Authorized Official - Middle Name:
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-993-6981
Mailing Address - Street 1:1229 BATTLECREEK RD STE 210
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:GA
Mailing Address - Zip Code:30236-2409
Mailing Address - Country:US
Mailing Address - Phone:770-471-5041
Mailing Address - Fax:
Practice Address - Street 1:1229 BATTLECREEK RD STE 210
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:GA
Practice Address - Zip Code:30236-2409
Practice Address - Country:US
Practice Address - Phone:770-471-5041
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-16
Last Update Date:2021-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
No251S00000XAgenciesCommunity/Behavioral Health
No261QH0700XAmbulatory Health Care FacilitiesClinic/CenterHearing and Speech