MEDICARE: NEW GENERATION AUTISTIC AND BEHAVIORAL CENTER 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	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1801724661
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NEW GENERATION AUTISTIC AND BEHAVIORAL CENTER LLC

Provider Business Mailing Address
First Line	:	805 GLYNN ST S STE 127-225
Second Line	:
City	:	FAYETTEVILLE
State	:	GA
Zip	:	30214-2000
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	165 AUTUMN MOON TRL
Second Line	:
City	:	FAYETTEVILLE
State	:	GA
Zip	:	30215-5091
Country	:	US
Telephone Number	:	770-716-2162
Fax Number	:

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	MR. FRANK JOHNSON
Credential	:
Telephone Number	:	678-895-5818

Provider Enumeration Date	:	05/12/2026
Last Update Date	:	05/12/2026

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