Healthcare Provider Details

I. General information

NPI: 1588236012
Provider Name (Legal Business Name): NINA EASON RBT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2021
Last Update Date: 09/10/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2044 WEEMS RD # A
TUCKER GA
30084-5207
US

IV. Provider business mailing address

2044 WEEMS RD # A
TUCKER GA
30084-5207
US

V. Phone/Fax

Practice location:
  • Phone: 470-870-6554
  • Fax:
Mailing address:
  • Phone: 470-870-6554
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-28-2848248
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-21-173402
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: