Healthcare Provider Details

I. General information

NPI: 1669391363
Provider Name (Legal Business Name): TRINITY ANIA PHILLIPS CAESAR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/15/2026
Last Update Date: 07/15/2026
Certification Date: 07/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3372 PEACHTREE RD NE STE 115
ATLANTA GA
30326-1963
US

IV. Provider business mailing address

1726 ROLLING VIEW WAY
DACULA GA
30019-4019
US

V. Phone/Fax

Practice location:
  • Phone: 877-414-3097
  • Fax:
Mailing address:
  • Phone: 943-245-9897
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-26-533046
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: