MEDICARE: MARKETTA SAVAGE-DOMINGUEZ BCBA

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	1-21-55443	GA

General Provider Information

NPI Number	:	1518552546
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARKETTA SAVAGE-DOMINGUEZ BCBA

Provider Business Mailing Address
First Line	:	2300 HENDERSON MILL RD NE STE 410
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30345-2704
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2300 HENDERSON MILL RD NE STE 410
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30345-2704
Country	:	US
Telephone Number	:	404-800-4057
Fax Number	:

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

Provider Enumeration Date	:	03/02/2021
Last Update Date	:	05/28/2026

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