Healthcare Provider Details

I. General information

NPI: 1992270201
Provider Name (Legal Business Name): LEYA HUSSAIN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/12/2018
Last Update Date: 11/09/2021
Certification Date: 11/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5050 RESEARCH CT STE 125
SUWANEE GA
30024-5573
US

IV. Provider business mailing address

5050 RESEARCH CT STE 125
SUWANEE GA
30024-5573
US

V. Phone/Fax

Practice location:
  • Phone: 404-410-7600
  • Fax:
Mailing address:
  • Phone: 404-410-7600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-21-53504
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: