Healthcare Provider Details

I. General information

NPI: 1548300965
Provider Name (Legal Business Name): JOHN C TRUSTY M.S., BCBA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/07/2007
Last Update Date: 08/28/2026
Certification Date: 08/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3091 HOLCOMB BRIDGE RD STE N1
NORCROSS GA
30071-1395
US

IV. Provider business mailing address

3845 ANSLEY PARK DR
SUWANEE GA
30024-6433
US

V. Phone/Fax

Practice location:
  • Phone: 470-219-8271
  • Fax:
Mailing address:
  • Phone: 470-219-8271
  • Fax: 877-597-8037

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License NumberLBA001306
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: