MEDICARE: APRICOTT GA LLC

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

General Provider Information

NPI Number	:	1417660127
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	APRICOTT GA LLC

Provider Business Mailing Address
First Line	:	12 BAYVIEW AVE UNIT 29
Second Line	:
City	:	LAWRENCE
State	:	NY
Zip	:	11559-4002
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	410 MALL BLVD STE G
Second Line	:
City	:	SAVANNAH
State	:	GA
Zip	:	31406-4869
Country	:	US
Telephone Number	:	615-200-6102
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR
Name	:	JOSEPH HARTMAN
Credential	:
Telephone Number	:	615-200-6102

Provider Enumeration Date	:	12/28/2022
Last Update Date	:	08/27/2024

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