MEDICARE: SUPREME ABCS LEARNING ACADEMY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225XN1300X	Neurorehabilitation Occupational Therapist

General Provider Information

NPI Number	:	1174452981
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SUPREME ABCS LEARNING ACADEMY

Provider Business Mailing Address
First Line	:	4200 WASHINGTON RD
Second Line	:
City	:	EAST POINT
State	:	GA
Zip	:	30344-7004
Country	:	US
Telephone Number	:	706-333-3422
Fax Number	:

Provider Business Practice Location Address
First Line	:	4200 WASHINGTON RD
Second Line	:
City	:	EAST POINT
State	:	GA
Zip	:	30344-7004
Country	:	US
Telephone Number	:	706-333-3422
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR
Name	:	MR. JAQUEZ POTTS
Credential	:
Telephone Number	:	706-333-3422

Provider Enumeration Date	:	05/18/2026
Last Update Date	:	05/18/2026

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