MEDICARE: ABIGAIL GONZALEZ MYERS

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	0082531	SC
2	106E00000X	Assistant Behavior Analyst

General Provider Information

NPI Number	:	1265678064
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ABIGAIL GONZALEZ MYERS

Provider Business Mailing Address
First Line	:	1321 MURFREESBORO PIKE STE 702
Second Line	:
City	:	NASHVILLE
State	:	TN
Zip	:	37217-2679
Country	:	US
Telephone Number	:	844-359-7629
Fax Number	:	615-577-5654

Provider Business Practice Location Address
First Line	:	1048 WILDWOOD CENTRE DR
Second Line	:
City	:	COLUMBIA
State	:	SC
Zip	:	29229-8420
Country	:	US
Telephone Number	:	803-999-3752
Fax Number	:	615-577-5654

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

Provider Enumeration Date	:	12/29/2008
Last Update Date	:	11/05/2020

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