MEDICARE: TITANIUM NEWCO GEORGIA 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	:	1518806413
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TITANIUM NEWCO GEORGIA LLC

Provider Business Mailing Address
First Line	:	8735 DUNWOODY PL STE N
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30350-2995
Country	:	US
Telephone Number	:	317-614-5677
Fax Number	:

Provider Business Practice Location Address
First Line	:	8735 DUNWOODY PL STE N
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30350-2995
Country	:	US
Telephone Number	:	317-614-5677
Fax Number	:

Authorized Official
Title or Position	:	CO-FOUNDER
Name	:	RICHARD RINK
Credential	:	MD
Telephone Number	:	317-614-5677

Provider Enumeration Date	:	03/26/2026
Last Update Date	:	03/26/2026

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