Healthcare Provider Details

I. General information

NPI: 1023964426
Provider Name (Legal Business Name): BLUE ABA GEORGIA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/09/2026
Last Update Date: 05/29/2026
Certification Date: 05/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

260 PEACHTREE ST NW STE 2200
ATLANTA GA
30303-1292
US

IV. Provider business mailing address

260 PEACHTREE ST NW STE 2200
ATLANTA GA
30303-1292
US

V. Phone/Fax

Practice location:
  • Phone: 404-282-8935
  • Fax: 623-748-1919
Mailing address:
  • Phone: 404-282-8935
  • Fax: 623-748-1919

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: GERSHON FINK
Title or Position: MANAGER
Credential: DO
Phone: 786-521-1587