MEDICARE: BRIGHT IMPACT BEHAVIORAL PRACTICES

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	:	1558232116
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BRIGHT IMPACT BEHAVIORAL PRACTICES

Provider Business Mailing Address
First Line	:	2001 MELROSE PL
Second Line	:
City	:	KATHLEEN
State	:	GA
Zip	:	31047-2873
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1012 GA-247
Second Line	:
City	:	KATHLEEN
State	:	GA
Zip	:	31047-2349
Country	:	US
Telephone Number	:	615-738-6463
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	BARRY IGUOBADIA
Credential	:	MD
Telephone Number	:	615-738-6463

Provider Enumeration Date	:	09/16/2025
Last Update Date	:	01/27/2026

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