MEDICARE: BRIGHTBRIDGE ABA GEORGIA LLC

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	:	1659228468
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BRIGHTBRIDGE ABA GEORGIA LLC

Provider Business Mailing Address
First Line	:	743 CENTRAL AVE
Second Line	:
City	:	WOODMERE
State	:	NY
Zip	:	11598-2614
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	743 CENTRAL AVE
Second Line	:
City	:	WOODMERE
State	:	NY
Zip	:	11598-2614
Country	:	US
Telephone Number	:	336-510-7910
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	LEONARD JEGER
Credential	:
Telephone Number	:	336-510-7910

Provider Enumeration Date	:	03/11/2026
Last Update Date	:	03/11/2026

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