Healthcare Provider Details

I. General information

NPI: 1154230142
Provider Name (Legal Business Name): MICHAEL FARRIS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/04/2026
Last Update Date: 09/04/2026
Certification Date: 09/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6225 ATLANTA HWY
ALPHARETTA GA
30004-8797
US

IV. Provider business mailing address

4810 MOSSBROOK CIR
ALPHARETTA GA
30004-2963
US

V. Phone/Fax

Practice location:
  • Phone: 770-530-7394
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-24-389165
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: