MEDICARE: DAEJIA STANLEY

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-25-456993	GA

General Provider Information

NPI Number	:	1356224984
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAEJIA STANLEY

Provider Business Mailing Address
First Line	:	6505 SHILOH RD STE 100
Second Line	:
City	:	ALPHARETTA
State	:	GA
Zip	:	30005-1645
Country	:	US
Telephone Number	:	678-648-7644
Fax Number	:

Provider Business Practice Location Address
First Line	:	3330 CHASTAIN MEADOWS PKWY NW STE 200
Second Line	:
City	:	KENNESAW
State	:	GA
Zip	:	30144-5881
Country	:	US
Telephone Number	:	678-648-7644
Fax Number	:

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

Provider Enumeration Date	:	07/30/2025
Last Update Date	:	06/05/2026

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Directions to “ DAEJIA STANLEY ” Practice Location

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