Provider Demographics
NPI:1326460403
Name:EBS CHILDREN'S THERAPY- GA, LLC
Entity Type:Organization
Organization Name:EBS CHILDREN'S THERAPY- GA, LLC
Other - Org Name:CHANDLER SPEECH AND LANGUAGE SERVICES LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:SLP
Authorized Official - Prefix:
Authorized Official - First Name:EMILY
Authorized Official - Middle Name:
Authorized Official - Last Name:CHANDLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-288-9770
Mailing Address - Street 1:4319 S LEE ST
Mailing Address - Street 2:SUITE 300
Mailing Address - City:BUFORD
Mailing Address - State:GA
Mailing Address - Zip Code:30518-5747
Mailing Address - Country:US
Mailing Address - Phone:678-288-9770
Mailing Address - Fax:678-288-9774
Practice Address - Street 1:4319 S LEE ST
Practice Address - Street 2:SUITE 300
Practice Address - City:BUFORD
Practice Address - State:GA
Practice Address - Zip Code:30518-5747
Practice Address - Country:US
Practice Address - Phone:678-288-9770
Practice Address - Fax:678-288-9774
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-09
Last Update Date:2022-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA288528985EMedicaid