Healthcare Provider Details

I. General information

NPI: 1710897400
Provider Name (Legal Business Name): SUMMIT IVY INCLUSION LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/08/2026
Last Update Date: 09/08/2026
Certification Date: 09/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2025 BENT CREEK MNR
ALPHARETTA GA
30005-8712
US

IV. Provider business mailing address

2012 BLOSSOM HILL DR
ROSWELL GA
30076-4237
US

V. Phone/Fax

Practice location:
  • Phone: 206-422-0009
  • Fax:
Mailing address:
  • Phone: 770-653-6146
  • 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: MR. AMIT SOOD
Title or Position: CO-FOUNDER
Credential:
Phone: 770-653-6146