MEDICARE: DENISE M DUNCAN 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	1-22-62698	GA

General Provider Information

NPI Number	:	1124839428
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DENISE M DUNCAN BCBA

Provider Business Mailing Address
First Line	:	3480 LONG LAKE DR
Second Line	:
City	:	DOUGLASVILLE
State	:	GA
Zip	:	30135-7620
Country	:	US
Telephone Number	:	909-718-9138
Fax Number	:

Provider Business Practice Location Address
First Line	:	5829 CAMPBELLTON RD SW
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30331-8037
Country	:	US
Telephone Number	:	770-940-0237
Fax Number	:

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

Provider Enumeration Date	:	01/15/2025
Last Update Date	:	01/15/2025

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