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NPI Code Detail

MEDICARE: SHAVONA ADDISON BCBA

MEDICARE: SHAVONA ADDISON 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
1171M00000XCase Manager/Care Coordinator
2103K00000XBehavior Analyst

General Provider Information

NPI Number : 1598268450
Entity Type Code : Individual
Provider Name (Legal Business Name) : SHAVONA ADDISON BCBA
Provider Business Mailing Address
First Line : 2550 TRADE CENTER DR STE G
Second Line :
City : EVANS
State : GA
Zip : 30809-6167
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 2550 TRADE CENTER DR STE G
Second Line :
City : EVANS
State : GA
Zip : 30809-6167
Country : US
Telephone Number : 706-723-8458
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/16/2018
Last Update Date : 02/03/2025

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Directions to “ SHAVONA ADDISON BCBA” Practice Location

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