MEDICARE: TIMYA JALISA MASSEY

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	106S00000X	Behavior Technician	RBT-24-383991	SC

General Provider Information

NPI Number	:	1144067950
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TIMYA JALISA MASSEY

Provider Business Mailing Address
First Line	:	209 7TH ST FL 3
Second Line	:
City	:	AUGUSTA
State	:	GA
Zip	:	30901-1486
Country	:	US
Telephone Number	:	706-842-5330
Fax Number	:	706-842-5340

Provider Business Practice Location Address
First Line	:	9361 TWO NOTCH RD
Second Line	:
City	:	COLUMBIA
State	:	SC
Zip	:	29223-6430
Country	:	US
Telephone Number	:	706-842-5330
Fax Number	:	706-842-5340

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

Provider Enumeration Date	:	07/09/2024
Last Update Date	:	03/05/2026

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