Healthcare Provider Details

I. General information

NPI: 1609712330
Provider Name (Legal Business Name): ASPEN HORIZON
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/27/2026
Last Update Date: 04/27/2026
Certification Date: 04/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

85 KATELEN CT
COVINGTON GA
30016-7720
US

IV. Provider business mailing address

85 KATELEN CT
COVINGTON GA
30016-7720
US

V. Phone/Fax

Practice location:
  • Phone: 470-334-3514
  • Fax:
Mailing address:
  • Phone: 470-334-3514
  • 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: JAVONTE GRAYER
Title or Position: OWNER
Credential:
Phone: 470-334-3514