Healthcare Provider Details

I. General information

NPI: 1770216301
Provider Name (Legal Business Name): ROCHELLE OBASUYI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/01/2022
Last Update Date: 07/06/2022
Certification Date: 07/06/2022
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

2288 LAVISTA RD NE APT 2
ATLANTA GA
30329-3338
US

V. Phone/Fax

Practice location:
  • Phone: 877-418-2978
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: