Healthcare Provider Details

I. General information

NPI: 1013858083
Provider Name (Legal Business Name): POSITIVE BEHAVIOR SUPPORTS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/03/2026
Last Update Date: 04/03/2026
Certification Date: 03/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 NORTHSIDE CROSSING,MACON STE A
MACON GA
31210-2377
US

IV. Provider business mailing address

7108 S KANNER HWY
STUART FL
34997-7462
US

V. Phone/Fax

Practice location:
  • Phone: 185-583-2672
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name: RAVEN DAVIS
Title or Position: BEHAVIOR TECHNICIAN
Credential:
Phone: 478-361-1615