Healthcare Provider Details

I. General information

NPI: 1710877832
Provider Name (Legal Business Name): EVERGREEN ABA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/09/2025
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: 229-391-1950
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 Number
License Number State

VIII. Authorized Official

Name: MELANIE ACKERMAN
Title or Position: PRESIDENT
Credential: M.ED., BCBA
Phone: 229-733-5565