Healthcare Provider Details

I. General information

NPI: 1003739269
Provider Name (Legal Business Name): MONTAZJA JAMELIA GRIFFIN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/03/2026
Last Update Date: 08/03/2026
Certification Date: 08/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

732 FLORENCE PL NW
ATLANTA GA
30318-5012
US

IV. Provider business mailing address

732 FLORENCE PL NW
ATLANTA GA
30318-5012
US

V. Phone/Fax

Practice location:
  • Phone: 470-848-4339
  • Fax:
Mailing address:
  • Phone: 470-848-4339
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-25-502302
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: