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General NPI Number Information
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NPI Number | 1003469420
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Entity Type | Organization
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Legal Business Name | BY YOUR SIDE GEORGIA, LLC
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Dates
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Enumeration Date | 07/24/2019
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Last Update Date | 11/23/2020
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Provider Practice Location Address
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Address Line | 3070 BUSINESS PARK DR STE B
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City | NORCROSS
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State | GA
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Zip | 30071-1428
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Country | US
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Telephone | 770-884-1050
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Fax | 770-884-1051
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Provider Business Mailing Address
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Address Line | 3070 BUSINESS PARK DR STE B
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City | NORCROSS
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State | GA
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Zip | 30071-1428
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Country | US
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Telephone | 770-884-1050
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Fax | 770-884-1051
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Authorized Official
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Title or Position | CFO
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Name | MATTHEW SULLIVAN
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Credential |
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Telephone | 770-884-1050
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number |
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License Number State |
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