Healthcare Provider Details

I. General information

NPI: 1497345524
Provider Name (Legal Business Name): COLTON TOMBERLIN BCBA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/22/2021
Last Update Date: 03/19/2024
Certification Date: 03/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

750 HAMMOND DR
ATLANTA GA
30328-5532
US

IV. Provider business mailing address

855 W PEACHTREE ST NE
ATLANTA GA
30308-1167
US

V. Phone/Fax

Practice location:
  • Phone: 470-344-9761
  • Fax:
Mailing address:
  • Phone: 813-767-0305
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-24-71914
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-21-152548
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: