Healthcare Provider Details

I. General information

NPI: 1821921198
Provider Name (Legal Business Name): ASHLYN RIVERS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/05/2026
Last Update Date: 06/05/2026
Certification Date: 06/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

413 WALDEN RUN PL
MCDONOUGH GA
30253-7004
US

IV. Provider business mailing address

413 WALDEN RUN PL
MCDONOUGH GA
30253-7004
US

V. Phone/Fax

Practice location:
  • Phone: 770-733-2937
  • Fax:
Mailing address:
  • Phone: 770-733-2937
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-25-469562
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: