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NPI Code Detail

MEDICARE: ANDREISY MAILLES MED

MEDICARE: ANDREISY MAILLES MED
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-15-07315GA
2103K00000XBehavior Analyst1-19-39689AL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1467835033
Entity Type Code : Individual
Provider Name (Legal Business Name) : ANDREISY MAILLES MED
Provider Business Mailing Address
First Line : 1921 WHITTLESEY RD STE 400
Second Line :
City : COLUMBUS
State : GA
Zip : 31904-9211
Country : US
Telephone Number : 706-221-9629
Fax Number : 706-243-6497
Provider Business Practice Location Address
First Line : 1921 WHITTLESEY RD STE 400
Second Line :
City : COLUMBUS
State : GA
Zip : 31904-9211
Country : US
Telephone Number : 706-229-9629
Fax Number : 706-243-6497
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/01/2015
Last Update Date : 05/04/2020

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