Healthcare Provider Details

I. General information

NPI: 1609478254
Provider Name (Legal Business Name): AJA NIXON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/09/2020
Last Update Date: 01/09/2026
Certification Date: 01/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3100 FIVE FORKS TRICKUM RD SW STE 203
LILBURN GA
30047-1887
US

IV. Provider business mailing address

230 SALEM GLEN WAY SE
CONYERS GA
30013-5330
US

V. Phone/Fax

Practice location:
  • Phone: 716-578-5610
  • Fax:
Mailing address:
  • Phone: 716-578-5619
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-26-86925
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: