Healthcare Provider Details

I. General information

NPI: 1205778115
Provider Name (Legal Business Name): DAIRA SELVAS FRANCO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/08/2026
Last Update Date: 04/08/2026
Certification Date: 04/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

360 JENKINS RD
TYRONE GA
30290-1614
US

IV. Provider business mailing address

6535 BUCKHURST TRL
ATLANTA GA
30349-4526
US

V. Phone/Fax

Practice location:
  • Phone: 770-969-2840
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-25-428416
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: