Healthcare Provider Details

I. General information

NPI: 1578326070
Provider Name (Legal Business Name): MORGAN ANDERSON BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/06/2024
Last Update Date: 09/10/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

259 ARROWHEAD BLVD
JONESBORO GA
30236-1167
US

IV. Provider business mailing address

4483 FLAT SHOALS RD APT S1
UNION CITY GA
30291-1562
US

V. Phone/Fax

Practice location:
  • Phone: 248-436-6561
  • Fax:
Mailing address:
  • Phone: 470-373-7728
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-26-2843708
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: