Healthcare Provider Details

I. General information

NPI: 1154885580
Provider Name (Legal Business Name): AMY THERESE SOLEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/30/2019
Last Update Date: 07/23/2025
Certification Date: 07/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

760 WATERMELON RD
TENNILLE GA
31089
US

IV. Provider business mailing address

760 WATERMELON RD
TENNILLE GA
31089
US

V. Phone/Fax

Practice location:
  • Phone: 478-232-4368
  • Fax:
Mailing address:
  • Phone: 478-232-4368
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-18-31181
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: