Healthcare Provider Details

I. General information

NPI: 1679498331
Provider Name (Legal Business Name): STACIE SIMMONS-MILLER RBT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

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

III. Provider practice location address

1894 LUDOVIE LN
DECATUR GA
30033-1044
US

IV. Provider business mailing address

1894 LUDOVIE LN
DECATUR GA
30033-1044
US

V. Phone/Fax

Practice location:
  • Phone: 678-626-0557
  • Fax: 678-288-7932
Mailing address:
  • Phone: 678-626-0557
  • Fax: 678-288-7932

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-24-395509
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: