MEDICARE: NYKIA GREEN

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-25-498253	GA

General Provider Information

NPI Number	:	1215891064
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NYKIA GREEN

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	:	1221 GEORGE C WILSON DR
Second Line	:
City	:	AUGUSTA
State	:	GA
Zip	:	30909-4502
Country	:	US
Telephone Number	:	706-842-5330
Fax Number	:	706-842-5340

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

Provider Enumeration Date	:	12/15/2025
Last Update Date	:	12/15/2025

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Directions to “ NYKIA GREEN ” Practice Location

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