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NPI Code Detail

MEDICARE: BY YOUR SIDE GEORGIA, LLC

MEDICARE: BY YOUR SIDE GEORGIA, LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225X00000XOccupational Therapist
2103K00000XBehavior Analyst

General Provider Information

NPI Number : 1003469420
Entity Type Code : Organization
Provider Name (Legal Business Name) : BY YOUR SIDE GEORGIA, LLC
Provider Business Mailing Address
First Line : 3070 BUSINESS PARK DR STE B
Second Line :
City : NORCROSS
State : GA
Zip : 30071-1428
Country : US
Telephone Number : 770-884-1050
Fax Number : 770-884-1051
Provider Business Practice Location Address
First Line : 3070 BUSINESS PARK DR STE B
Second Line :
City : NORCROSS
State : GA
Zip : 30071-1428
Country : US
Telephone Number : 770-884-1050
Fax Number : 770-884-1051
Authorized Official
Title or Position : CFO
Name : MATTHEW SULLIVAN
Credential :
Telephone Number : 770-884-1050
Provider Enumeration Date : 07/24/2019
Last Update Date : 11/23/2020

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Directions to “BY YOUR SIDE GEORGIA, LLC ” Practice Location

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These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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