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NPI Code Detail

MEDICARE: BENJAMIN TYLER FOWLER BCBA

MEDICARE: BENJAMIN TYLER FOWLER BCBA
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
1103K00000XBehavior Analyst1-26-90082GA

General Provider Information

NPI Number : 1184362758
Entity Type Code : Individual
Provider Name (Legal Business Name) : BENJAMIN TYLER FOWLER BCBA
Provider Business Mailing Address
First Line : 5050 RESEARCH CT STE 125
Second Line :
City : SUWANEE
State : GA
Zip : 30024-5573
Country : US
Telephone Number : 404-410-7600
Fax Number :
Provider Business Practice Location Address
First Line : 311 MARGIE DR
Second Line :
City : WARNER ROBINS
State : GA
Zip : 31088-7818
Country : US
Telephone Number : 404-410-7600
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/24/2022
Last Update Date : 05/22/2026

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