Healthcare Provider Details

I. General information

NPI: 1285566026
Provider Name (Legal Business Name): MARIA RADOMSKI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/03/2026
Last Update Date: 06/03/2026
Certification Date: 06/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7413 WHITESVILLE RD STE 600
COLUMBUS GA
31904-3231
US

IV. Provider business mailing address

3343 PEACHTREE RD NE STE 145-1219
ATLANTA GA
30326-1085
US

V. Phone/Fax

Practice location:
  • Phone: 317-572-5315
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-25-465524
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: