Provider Demographics
NPI:1356818017
Name:GREAT START DEVELOPMENT CENTER, LLC
Entity Type:Organization
Organization Name:GREAT START DEVELOPMENT CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:SAMANTHA
Authorized Official - Middle Name:
Authorized Official - Last Name:GRAY MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-713-6486
Mailing Address - Street 1:975 COBB PLACE BLVD NW STE 101
Mailing Address - Street 2:
Mailing Address - City:KENNESAW
Mailing Address - State:GA
Mailing Address - Zip Code:30144-6848
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:975 COBB PLACE BLVD NW STE 101
Practice Address - Street 2:
Practice Address - City:KENNESAW
Practice Address - State:GA
Practice Address - Zip Code:30144-6848
Practice Address - Country:US
Practice Address - Phone:770-713-6486
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-30
Last Update Date:2018-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency
Provider Identifiers
StateIdentifier IDID TypeIssuer
252Y00000XOtherPROVIDER FOR BABIES CAN'T WAIT