MEDICARE: INNA DEMINA

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		GA

General Provider Information

NPI Number	:	1114662749
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	INNA DEMINA

Provider Business Mailing Address
First Line	:	5180 CAMERON FOREST PKWY
Second Line	:
City	:	ALPHARETTA
State	:	GA
Zip	:	30022-4597
Country	:	US
Telephone Number	:	786-417-3580
Fax Number	:

Provider Business Practice Location Address
First Line	:	3775 VENTURE DR UNIT M
Second Line	:
City	:	DULUTH
State	:	GA
Zip	:	30096-5102
Country	:	US
Telephone Number	:	470-610-4222
Fax Number	:

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

Provider Enumeration Date	:	04/28/2022
Last Update Date	:	05/08/2024

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Directions to “ INNA DEMINA ” Practice Location

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