Healthcare Provider Details

I. General information

NPI: 1063029734
Provider Name (Legal Business Name): JAMIE GAWTHROP BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/28/2020
Last Update Date: 06/06/2024
Certification Date: 06/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

740 E GENERAL STEWART WAY STE 103
HINESVILLE GA
31313-2636
US

IV. Provider business mailing address

740 E GENERAL STEWART WAY STE 103
HINESVILLE GA
31313-2636
US

V. Phone/Fax

Practice location:
  • Phone: 877-321-2899
  • Fax: 877-540-0182
Mailing address:
  • Phone: 877-321-2899
  • Fax: 877-540-0182

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-20-137056
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: