MEDICARE: SATA SEEDS 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	:	1548090590
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SATA SEEDS LLC

Provider Business Mailing Address
First Line	:	1109 VILLA POINT PKWY
Second Line	:
City	:	MCDONOUGH
State	:	GA
Zip	:	30253-9227
Country	:	US
Telephone Number	:	302-567-8592
Fax Number	:

Provider Business Practice Location Address
First Line	:	1109 VILLA POINT PKWY
Second Line	:
City	:	MCDONOUGH
State	:	GA
Zip	:	30253-9227
Country	:	US
Telephone Number	:	302-567-8592
Fax Number	:

Authorized Official
Title or Position	:	CEO/RBT
Name	:	JALEEL T. WISE
Credential	:	RBT
Telephone Number	:	302-567-8592

Provider Enumeration Date	:	08/05/2024
Last Update Date	:	08/05/2024

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Directions to “SATA SEEDS LLC ” Practice Location

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