| Marvelous Light Consultants | |
|
4484 Covington Hwy Suite 100a Decatur GA 30035-1203 | |
| (404) 286-0054 | |
| (404) 286-0064 |
| Full Name | Marvelous Light Consultants |
|---|---|
| Speciality | Counselor |
| Location | 4484 Covington Hwy, Decatur, Georgia |
| Authorized Official Name and Position | Dewanda B. Jackson (CEO) |
| Authorized Official Contact | 4042860054 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Marvelous Light Consultants Po Box 1501 Lithonia GA 30058-1007 Ph: (404) 286-0054 | Marvelous Light Consultants 4484 Covington Hwy Suite 100a Decatur GA 30035-1203 Ph: (404) 286-0054 |
| NPI Number | 1922145325 |
|---|---|
| Provider Enumeration Date | 02/01/2007 |
| Last Update Date | 06/19/2008 |
| Medicare PECOS PAC ID | 5799030979 |
|---|---|
| Medicare Enrollment ID | O20180611002481 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1922145325 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YP2500X | Counselor - Professional | LPC002390 (Georgia) | Primary |
| Provider Name | Devon Briggs |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1649259714 PECOS PAC ID: 9436179769 Enrollment ID: I20051201000706 |
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