Healthcare Provider Details

I. General information

NPI: 1821914920
Provider Name (Legal Business Name): BRETT HARRISON
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/24/2026
Last Update Date: 06/24/2026
Certification Date: 06/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

919 REGENCY PATH DR
DECATUR GA
30030-4168
US

IV. Provider business mailing address

1285 CONWAY RD
DECATUR GA
30030-4570
US

V. Phone/Fax

Practice location:
  • Phone: 706-572-4591
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number26-541416
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: