Healthcare Provider Details

I. General information

NPI: 1518708627
Provider Name (Legal Business Name): GRAY'S PURPOSE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/03/2024
Last Update Date: 06/03/2024
Certification Date: 05/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

510 RYAN CT.
BALL GROUND GA
30107
US

IV. Provider business mailing address

108 RIVERSTONE PKWY # 1029
CANTON GA
30114-2448
US

V. Phone/Fax

Practice location:
  • Phone: 404-805-4971
  • 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
# 2
Primary TaxonomyN
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name: PRESLIE NIXON
Title or Position: OWNER BCBA
Credential:
Phone: 404-805-4971