Healthcare Provider Details

I. General information

NPI: 1710573449
Provider Name (Legal Business Name): ABA SPECIALISTS ATLANTA LLLP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/16/2020
Last Update Date: 02/23/2021
Certification Date: 02/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3775 VENTURE DR STE M101
DULUTH GA
30096-5217
US

IV. Provider business mailing address

3775 VENTURE DR STE M101
DULUTH GA
30096-5217
US

V. Phone/Fax

Practice location:
  • Phone: 470-610-4222
  • Fax:
Mailing address:
  • Phone: 470-610-4222
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: FRANCISCO J MATOS
Title or Position: CEO
Credential:
Phone: 404-528-3766