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NPI Code Detail

MEDICARE: PATRICK GEORGE THORBOURNE MED ; BCBA

MEDICARE: PATRICK GEORGE THORBOURNE MED ; 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
1103K00000XBehavior Analyst
2106E00000XAssistant Behavior Analyst
3106S00000XBehavior Technician
4103K00000XBehavior Analyst1-19-38615GA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
11-19-38615OTHERGABCBA CERTIFICATE

General Provider Information

NPI Number : 1699133975
Entity Type Code : Individual
Provider Name (Legal Business Name) : PATRICK GEORGE THORBOURNE MED ; BCBA
Provider Business Mailing Address
First Line : 3500 DEPAUW BLVD STE 3070
Second Line :
City : INDIANAPOLIS
State : IN
Zip : 46268-6135
Country : US
Telephone Number : 317-516-6489
Fax Number :
Provider Business Practice Location Address
First Line : 3800 CAMP CREEK PKWY SW BLDG 1400
Second Line :
City : ATLANTA
State : GA
Zip : 30331-6247
Country : US
Telephone Number : 770-999-9271
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/02/2016
Last Update Date : 03/04/2020

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