Healthcare Provider Details

I. General information

NPI: 1437645454
Provider Name (Legal Business Name): FLORIDA AUTISM CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/02/2018
Last Update Date: 11/08/2022
Certification Date: 11/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4390 PLEASANT HILL RD
DULUTH GA
30096-8054
US

IV. Provider business mailing address

300 INTERNATIONAL PKWY STE 200
LAKE MARY FL
32746-5028
US

V. Phone/Fax

Practice location:
  • Phone: 866-610-0590
  • Fax:
Mailing address:
  • Phone: 470-816-6449
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name: JASON OWEN
Title or Position: CEO
Credential:
Phone: 470-816-6449