Healthcare Provider Details

I. General information

NPI: 1669396024
Provider Name (Legal Business Name): ARMS WIDE OPEN GA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/07/2026
Last Update Date: 08/07/2026
Certification Date: 07/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

823 BROAD ST
AUGUSTA GA
30901-1214
US

IV. Provider business mailing address

823 BROAD ST
AUGUSTA GA
30901-1214
US

V. Phone/Fax

Practice location:
  • Phone: 706-478-5505
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name: EFRAIM COOPER
Title or Position: COO
Credential:
Phone: 605-401-6143