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NPI Code Detail

MEDICARE: ATLAS AUTISM CENTER

MEDICARE: ATLAS AUTISM CENTER
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

General Provider Information

NPI Number : 1841936457
Entity Type Code : Organization
Provider Name (Legal Business Name) : ATLAS AUTISM CENTER
Provider Business Mailing Address
First Line : 640 SW CARDINAL DR
Second Line :
City : KEYSTONE HEIGHTS
State : FL
Zip : 32656-7117
Country : US
Telephone Number : 352-284-6057
Fax Number :
Provider Business Practice Location Address
First Line : 5921 BEMISS RD
Second Line :
City : VALDOSTA
State : GA
Zip : 31605-7520
Country : US
Telephone Number : 352-284-6057
Fax Number :
Authorized Official
Title or Position : OFFICE MANAGER
Name : JENNIFER HATCH
Credential :
Telephone Number : 352-284-6057
Provider Enumeration Date : 05/06/2022
Last Update Date : 06/29/2022

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Directions to “ATLAS AUTISM CENTER ” Practice Location

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