MEDICARE: CURTIS LOGAN EVERITT BCABA

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	106S00000X	Behavior Technician	RBT-20-125318	GA
2	106E00000X	Assistant Behavior Analyst	0-23-14593	GA

General Provider Information

NPI Number	:	1447877634
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CURTIS LOGAN EVERITT BCABA

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	:	1230 JOHNSON FERRY PL STE B10
Second Line	:
City	:	MARIETTA
State	:	GA
Zip	:	30068-2044
Country	:	US
Telephone Number	:	404-410-7600
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/03/2020
Last Update Date	:	10/25/2023

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