MEDICARE: MRS. AMANDA MARIE BRATTAIN 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
1	103K00000X	Behavior Analyst	1-21-50056	GA
2	103K00000X	Behavior Analyst	LBA001277	GA

General Provider Information

NPI Number	:	1891285797
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. AMANDA MARIE BRATTAIN BCBA

Provider Business Mailing Address
First Line	:	542 AMHERST ST STE B
Second Line	:
City	:	NASHUA
State	:	NH
Zip	:	03063-1016
Country	:	US
Telephone Number	:	866-610-0580
Fax Number	:	407-588-6294

Provider Business Practice Location Address
First Line	:	3098 PIEDMONT RD NE STE 200
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30305-2600
Country	:	US
Telephone Number	:	855-724-9356
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/16/2018
Last Update Date	:	03/04/2026

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