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General NPI Number Information
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NPI Number | 1609504851
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Entity Type | Organization
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Legal Business Name | SUNRISE ABA OF GEORGIA LLC
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Dates
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Enumeration Date | 08/15/2022
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Last Update Date | 08/15/2022
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Provider Practice Location Address
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Address Line | 4827 OLD NATIONAL HWY STE 10011
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City | ATLANTA
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State | GA
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Zip | 30337-6234
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Country | US
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Telephone | 628-250-7500
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Fax |
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Provider Business Mailing Address
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Address Line | 505 SAN MARIN DR STE 100B
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City | NOVATO
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State | CA
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Zip | 94945-1309
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Country | US
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Telephone | 628-250-7500
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Fax |
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Authorized Official
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Title or Position | DIRECTOR OF OPERATIONS
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Name | BRADY KEITH
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Credential |
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Telephone | 628-250-7500
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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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