MEDICARE: ABA SPECIALISTS ATLANTA LLLP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	106E00000X	Assistant Behavior Analyst
2	106S00000X	Behavior Technician
3	235Z00000X	Speech-Language Pathologist
4	103K00000X	Behavior Analyst

General Provider Information

NPI Number	:	1710573449
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ABA SPECIALISTS ATLANTA LLLP

Provider Business Mailing Address
First Line	:	3775 VENTURE DR STE M101
Second Line	:
City	:	DULUTH
State	:	GA
Zip	:	30096-5217
Country	:	US
Telephone Number	:	470-610-4222
Fax Number	:

Provider Business Practice Location Address
First Line	:	3775 VENTURE DR STE M101
Second Line	:
City	:	DULUTH
State	:	GA
Zip	:	30096-5217
Country	:	US
Telephone Number	:	470-610-4222
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	FRANCISCO J MATOS
Credential	:
Telephone Number	:	404-528-3766

Provider Enumeration Date	:	12/16/2020
Last Update Date	:	02/23/2021

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Directions to “ABA SPECIALISTS ATLANTA LLLP ” Practice Location

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