Healthcare Provider Details

I. General information

NPI: 1720714033
Provider Name (Legal Business Name): SARAH ANN REBUELTA BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/28/2022
Last Update Date: 12/08/2025
Certification Date: 12/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

322 BOB THOMAS RD
JACKSON GA
30233-6725
US

IV. Provider business mailing address

322 BOB THOMAS RD
JACKSON GA
30233-6725
US

V. Phone/Fax

Practice location:
  • Phone: 404-567-9029
  • Fax:
Mailing address:
  • Phone: 404-567-9029
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-25-86198
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: