Healthcare Provider Details

I. General information

NPI: 1922720846
Provider Name (Legal Business Name): SYDNIE LEEANN FORDHAM BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/16/2022
Last Update Date: 02/02/2026
Certification Date: 02/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 GRAND CENTRAL BLVD
POOLER GA
31322-4148
US

IV. Provider business mailing address

98 BROGDON RD.
GUYTON GA
31312
US

V. Phone/Fax

Practice location:
  • Phone: 912-244-3305
  • Fax:
Mailing address:
  • Phone: 912-675-5409
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License NumberLBA001803
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: