MEDICARE: SOUTHERN BEHAVIORAL GROUP

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	:	1356575070
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUTHERN BEHAVIORAL GROUP

Provider Business Mailing Address
First Line	:	1950 SPECTRUM CIR SE
Second Line	:	SUITE 400
City	:	MARIETTA
State	:	GA
Zip	:	30067-8479
Country	:	US
Telephone Number	:	678-921-2811
Fax Number	:

Provider Business Practice Location Address
First Line	:	1950 SPECTRUM CIR SE
Second Line	:	SUITE 400
City	:	MARIETTA
State	:	GA
Zip	:	30067-8479
Country	:	US
Telephone Number	:	678-921-2811
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR OF BEHAVIORAL SERVICES
Name	:	DR. MICHAEL MUELLER
Credential	:	PH.D., BCBA
Telephone Number	:	678-921-2811

Provider Enumeration Date	:	05/09/2009
Last Update Date	:	05/09/2009

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