Healthcare Provider Details

I. General information

NPI: 1619833779
Provider Name (Legal Business Name): MRS. ALEIZA M DE JESUS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/01/2026
Last Update Date: 01/01/2026
Certification Date: 01/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2451B US HIGHWAY 17
RICHMOND HILL GA
31324-3397
US

IV. Provider business mailing address

32 PALMER PLACE LN NE
LUDOWICI GA
31316-6788
US

V. Phone/Fax

Practice location:
  • Phone: 615-590-6622
  • Fax: 615-560-6636
Mailing address:
  • Phone: 615-590-6622
  • Fax: 615-560-6636

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: