MEDICARE: MEGAN GABRIEL

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	1-20-44457	GA
2	106S00000X	Behavior Technician	RBT-20-122954	GA

General Provider Information

NPI Number	:	1730704636
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MEGAN GABRIEL

Provider Business Mailing Address
First Line	:	1415 HIGHWAY 70
Second Line	:
City	:	NEWNAN
State	:	GA
Zip	:	30263-4720
Country	:	US
Telephone Number	:	770-283-7961
Fax Number	:

Provider Business Practice Location Address
First Line	:	112 JEFFERSON STREET
Second Line	:
City	:	NEWNAN
State	:	GA
Zip	:	30263
Country	:	US
Telephone Number	:	877-288-4760
Fax Number	:

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

Provider Enumeration Date	:	06/16/2020
Last Update Date	:	06/03/2026

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Directions to “ MEGAN GABRIEL ” Practice Location

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