MEDICARE: CHERRY BLOSSOM AUTISM CENTER, 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	:	1487503397
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHERRY BLOSSOM AUTISM CENTER, LLC

Provider Business Mailing Address
First Line	:	4929 FAWNWOOD DR
Second Line	:
City	:	GAINESVILLE
State	:	GA
Zip	:	30504-8117
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4929 FAWNWOOD DR
Second Line	:
City	:	GAINESVILLE
State	:	GA
Zip	:	30504-8117
Country	:	US
Telephone Number	:	912-247-0810
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	JAMES BURNETT
Credential	:	BCBA, LBA-GA
Telephone Number	:	912-247-0810

Provider Enumeration Date	:	01/23/2026
Last Update Date	:	01/23/2026

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