MEDICARE: MAE LAX

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

General Provider Information

NPI Number	:	1487463808
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MAE LAX

Provider Business Mailing Address
First Line	:	2357 WARM SPRINGS RD STE 119
Second Line	:
City	:	COLUMBUS
State	:	GA
Zip	:	31904-5690
Country	:	US
Telephone Number	:	229-458-9165
Fax Number	:

Provider Business Practice Location Address
First Line	:	2357 WARM SPRINGS RD STE 119
Second Line	:
City	:	COLUMBUS
State	:	GA
Zip	:	31904-5690
Country	:	US
Telephone Number	:	229-458-9165
Fax Number	:

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

Provider Enumeration Date	:	12/31/2024
Last Update Date	:	12/31/2024

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Directions to “ MAE LAX ” Practice Location

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