Healthcare Provider Details

I. General information

NPI: 1386581528
Provider Name (Legal Business Name): DEVELOPMENTAL CENTERS OF GEORGIA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/04/2026
Last Update Date: 05/04/2026
Certification Date: 05/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 SE PORT ST LUCIE BLVD UNIT 3
PORT SAINT LUCIE FL
34984-5108
US

IV. Provider business mailing address

550 SE PORT ST LUCIE BLVD UNIT 3
PORT SAINT LUCIE FL
34984-5108
US

V. Phone/Fax

Practice location:
  • Phone: 954-825-3317
  • Fax:
Mailing address:
  • Phone: 954-825-3317
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name: THEODS FULMORE JR.
Title or Position: OFFICE MANAGER
Credential:
Phone: 954-825-3317