Healthcare Provider Details

I. General information

NPI: 1790648632
Provider Name (Legal Business Name): PRACTICAL BEHAVIORAL CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/08/2025
Last Update Date: 12/08/2025
Certification Date: 12/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 W PEACHTREE ST NW STE 2300
ATLANTA GA
30309-3453
US

IV. Provider business mailing address

1201 W PEACHTREE ST NW STE 2300
ATLANTA GA
30309-3453
US

V. Phone/Fax

Practice location:
  • Phone: 678-765-9900
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: NYCOLE ASHLEY COX
Title or Position: NURSE PRACTITIONER
Credential: NP-C
Phone: 330-998-8033