Healthcare Provider Details

I. General information

NPI: 1134035355
Provider Name (Legal Business Name): SIRAD ABA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/19/2026
Last Update Date: 08/19/2026
Certification Date: 08/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2088 IDLEWOOD RD STE 5
TUCKER GA
30084-6264
US

IV. Provider business mailing address

5016 OWEN MILL TRL
STONE MOUNTAIN GA
30083-3661
US

V. Phone/Fax

Practice location:
  • Phone: 404-514-6085
  • Fax:
Mailing address:
  • Phone: 404-514-6896
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name: NAJMA JAMA KASSIM
Title or Position: OWNER
Credential: CEO
Phone: 404-514-6085