Healthcare Provider Details

I. General information

NPI: 1548944523
Provider Name (Legal Business Name): CARLOS JAVIER GUZMAN BCBA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2023
Last Update Date: 08/31/2026
Certification Date: 08/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2103 CAIN CIR STE 100
DACULA GA
30019-1658
US

IV. Provider business mailing address

178 JOSHUA WAY
HOSCHTON GA
30548-6400
US

V. Phone/Fax

Practice location:
  • Phone: 770-944-4347
  • Fax:
Mailing address:
  • Phone: 770-540-9290
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License NumberBACB1-25-81900
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License NumberLBA000133
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: