MEDICARE: MR. PAUL MICAH FRIDDLE M.S., BCBA

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	103K00000X	Behavior Analyst

General Provider Information

NPI Number	:	1083927602
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. PAUL MICAH FRIDDLE M.S., BCBA

Provider Business Mailing Address
First Line	:	300 INTERNATIONAL PKWY STE 200
Second Line	:
City	:	LAKE MARY
State	:	FL
Zip	:	32746-5028
Country	:	US
Telephone Number	:	866-610-0580
Fax Number	:	407-588-6294

Provider Business Practice Location Address
First Line	:	1155 CONCORD RD SE STE 220
Second Line	:
City	:	SMYRNA
State	:	GA
Zip	:	30080-4255
Country	:	US
Telephone Number	:	470-666-2550
Fax Number	:	470-509-4895

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/24/2010
Last Update Date	:	09/08/2022

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