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NPI Code Detail

MEDICARE: BENJAMIN TRAD

MEDICARE: BENJAMIN TRAD
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
1106E00000XAssistant Behavior AnalystGA

General Provider Information

NPI Number : 1063083624
Entity Type Code : Individual
Provider Name (Legal Business Name) : BENJAMIN TRAD
Provider Business Mailing Address
First Line : 10164 FORD AVE STE D
Second Line :
City : RICHMOND HILL
State : GA
Zip : 31324-3948
Country : US
Telephone Number : 912-459-9999
Fax Number :
Provider Business Practice Location Address
First Line : 10164 FORD AVE STE D
Second Line :
City : RICHMOND HILL
State : GA
Zip : 31324-3948
Country : US
Telephone Number : 912-459-9999
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/06/2021
Last Update Date : 07/06/2021

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Directions to “ BENJAMIN TRAD ” Practice Location

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