Southside Aba Llc | |
1135 Senoia Rd Tyrone GA 30290-1625 | |
(770) 626-3044 | |
(470) 200-2269 |
Full Name | Southside Aba Llc |
---|---|
Speciality | Behavior Analyst |
Location | 1135 Senoia Rd, Tyrone, Georgia |
Authorized Official Name and Position | Christine Elaine Marrero (CLINICAL DIRECTOR) |
Authorized Official Contact | 7707076367 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
---|---|
Southside Aba Llc 1135 Senoia Rd Tyrone GA 30290-1625 Ph: (770) 626-3044 | Southside Aba Llc 1135 Senoia Rd Tyrone GA 30290-1625 Ph: (770) 626-3044 |
NPI Number | 1134759608 |
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Provider Enumeration Date | 01/23/2020 |
Last Update Date | 01/23/2020 |
Certification Date | 01/23/2020 |
Identifier | Type | State | Issuer |
---|---|---|---|
1134759608 | NPI | - | NPPES |
003218736A | Medicaid | GA |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
103K00000X | Behavior Analyst | (* (Not Available)) | Primary |
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