MEDICARE: NEURO CENTER FOR PEDIATRIC DEVELOPMENT

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	:	1740137306
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NEURO CENTER FOR PEDIATRIC DEVELOPMENT

Provider Business Mailing Address
First Line	:	131 CANAL ST STE C
Second Line	:
City	:	POOLER
State	:	GA
Zip	:	31322-6019
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	131 CANAL ST STE C
Second Line	:
City	:	POOLER
State	:	GA
Zip	:	31322-6019
Country	:	US
Telephone Number	:	912-482-3461
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR
Name	:	NICOLE NWOKEY
Credential	:
Telephone Number	:	912-482-3461

Provider Enumeration Date	:	03/12/2026
Last Update Date	:	04/04/2026

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Directions to “NEURO CENTER FOR PEDIATRIC DEVELOPMENT ” Practice Location

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