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NPI Code Detail

MEDICARE: ETNEY TULLENERS RBT

MEDICARE: ETNEY TULLENERS RBT
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
1106S00000XBehavior TechnicianRBT-26-528515GA

General Provider Information

NPI Number : 1225971765
Entity Type Code : Individual
Provider Name (Legal Business Name) : ETNEY TULLENERS RBT
Provider Business Mailing Address
First Line : 3511 CREATWOOD TRL SE
Second Line :
City : SMYRNA
State : GA
Zip : 30080-4530
Country : US
Telephone Number : 470-331-8568
Fax Number :
Provider Business Practice Location Address
First Line : 6371 SEYMOUR PL NW
Second Line :
City : ACWORTH
State : GA
Zip : 30101-8063
Country : US
Telephone Number : 770-508-0686
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/10/2026
Last Update Date : 04/10/2026

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Directions to “ ETNEY TULLENERS RBT” Practice Location

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