MEDICARE: LUMA AUTISM, INC.

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	103K00000X	Behavior Analyst

General Provider Information

NPI Number	:	1265129977
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LUMA AUTISM, INC.

Provider Business Mailing Address
First Line	:	6075 BARFIELD RD
Second Line	:
City	:	SANDY SPRINGS
State	:	GA
Zip	:	30328-4402
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6075 BARFIELD RD
Second Line	:
City	:	SANDY SPRINGS
State	:	GA
Zip	:	30328-4402
Country	:	US
Telephone Number	:	404-884-3834
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	VIRAL PAREKH
Credential	:
Telephone Number	:	404-884-3834

Provider Enumeration Date	:	04/21/2023
Last Update Date	:	04/21/2023

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Directions to “LUMA AUTISM, INC. ” Practice Location

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