MEDICARE: EMILY RAE GOMES 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	1-18-30388

General Provider Information

NPI Number	:	1184106247
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EMILY RAE GOMES BCBA

Provider Business Mailing Address
First Line	:	2102 BROOKHAVEN VW NE
Second Line	:
City	:	BROOKHAVEN
State	:	GA
Zip	:	30319-3195
Country	:	US
Telephone Number	:	770-862-5645
Fax Number	:

Provider Business Practice Location Address
First Line	:	1215 HIGHTOWER TRL
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30350-6244
Country	:	US
Telephone Number	:	770-862-5645
Fax Number	:

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

Provider Enumeration Date	:	09/05/2018
Last Update Date	:	12/23/2025

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