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General NPI Number Information
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NPI Number | 1386581528
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Entity Type | Organization
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Legal Business Name | DEVELOPMENTAL CENTERS OF GEORGIA
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Dates
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Enumeration Date | 05/04/2026
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Last Update Date | 05/04/2026
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Provider Practice Location Address
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Address Line | 550 SE PORT ST LUCIE BLVD UNIT 3
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City | PORT SAINT LUCIE
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State | FL
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Zip | 34984-5108
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Country | US
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Telephone | 954-825-3317
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Fax |
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Provider Business Mailing Address
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Address Line | 550 SE PORT ST LUCIE BLVD UNIT 3
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City | PORT SAINT LUCIE
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State | FL
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Zip | 34984-5108
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Country | US
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Telephone | 954-825-3317
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Fax |
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | THEODS FULMORE JR.
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Credential |
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Telephone | 954-825-3317
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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