| Moon River, Llc | |
|
790 Oak Trail Dr Marietta GA 30062-7502 | |
| (770) 977-6866 | |
| (770) 977-6887 |
| Full Name | Moon River, Llc |
|---|---|
| Speciality | Behavior Analyst |
| Location | 790 Oak Trail Dr, Marietta, Georgia |
| Authorized Official Name and Position | Laura Desantis (OFFICE MANAGER) |
| Authorized Official Contact | 7702122170 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Moon River, Llc 790 Oak Trail Dr Marietta GA 30062-7502 Ph: (770) 212-2170 | Moon River, Llc 790 Oak Trail Dr Marietta GA 30062-7502 Ph: (770) 977-6866 |
| NPI Number | 1730143553 |
|---|---|
| Provider Enumeration Date | 04/17/2006 |
| Last Update Date | 02/18/2025 |
| Certification Date | 02/18/2025 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1730143553 | NPI | - | NPPES |
| 000970835A | Medicaid | GA | |
| 317872221A | Medicaid | GA | |
| 503885675B | Medicaid | GA | |
| 315889908A | Medicaid | GA | |
| 339518223A | Medicaid | GA | |
| 516643175A | Medicaid | GA | |
| 761415888A | Medicaid | GA | |
| 765677599A | Medicaid | GA | |
| 814363142A | Medicaid | GA | |
| 188883028B | Medicaid | GA | |
| 426315361A | Medicaid | GA | |
| 000753563E | Medicaid | GA | |
| 191707573A | Medicaid | GA | |
| 461168837A | Medicaid | GA | |
| 481436178B | Medicaid | GA | |
| 000860736B | Medicaid | GA | |
| 240960806A | Medicaid | GA | |
| 850524466A | Medicaid | GA | |
| 146855825A | Medicaid | GA | |
| 986209149B | Medicaid | GA |
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