Healthcare Provider Details

I. General information

NPI: 1154218394
Provider Name (Legal Business Name): BRAYDEN EMILIE STATON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/20/2025
Last Update Date: 06/30/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1967 JESSIE JEWELL PKWY SE
GAINESVILLE GA
30501
US

IV. Provider business mailing address

331 MODOC DR
CORNELIA GA
30531-2136
US

V. Phone/Fax

Practice location:
  • Phone: 404-590-2281
  • Fax:
Mailing address:
  • Phone: 706-949-5942
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-26-2826296
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: