MEDICARE: PERSPECTIVES DEVELOPMENTAL GROUP

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	:	1518502194
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PERSPECTIVES DEVELOPMENTAL GROUP

Provider Business Mailing Address
First Line	:	3207 HENDERSON MILL RD APT T4
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30341-6019
Country	:	US
Telephone Number	:	352-246-4640
Fax Number	:

Provider Business Practice Location Address
First Line	:	3207 HENDERSON MILL RD APT T4
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30341-6019
Country	:	US
Telephone Number	:	352-246-4640
Fax Number	:

Authorized Official
Title or Position	:	BCBA
Name	:	KAYLA ALEXANDRIA GREENE
Credential	:
Telephone Number	:	352-246-4640

Provider Enumeration Date	:	11/07/2019
Last Update Date	:	11/07/2019

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