Healthcare Provider Details

I. General information

NPI: 1083246748
Provider Name (Legal Business Name): MELANIE RAYE ACKERMAN BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/10/2020
Last Update Date: 06/18/2026
Certification Date: 06/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

496 MEDLOCK RD
DECATUR GA
30030-1566
US

IV. Provider business mailing address

496 MEDLOCK RD
DECATUR GA
30030-1566
US

V. Phone/Fax

Practice location:
  • Phone: 229-733-5565
  • Fax: 229-391-9150
Mailing address:
  • Phone: 229-733-5565
  • Fax: 229-391-1950

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-20-40593
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: