MEDICARE: EARLY AUTISM PROJECT, INC.

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
1	251S00000X	Community/Behavioral Health Agency

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1033427471
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EARLY AUTISM PROJECT, INC.

Provider Business Mailing Address
First Line	:	PO BOX 931142
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	31193-1142
Country	:	US
Telephone Number	:	615-696-6761
Fax Number	:	615-880-5782

Provider Business Practice Location Address
First Line	:	3217 S MACDILL AVE
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33629-1719
Country	:	US
Telephone Number	:	615-569-1314
Fax Number	:	615-577-5654

Authorized Official
Title or Position	:	REVENUE CYCLE MANAGER
Name	:	JESSICA KIRK
Credential	:
Telephone Number	:	615-880-5782

Provider Enumeration Date	:	09/20/2010
Last Update Date	:	08/31/2023

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