MEDICARE: DOUBLECARE ABA GA 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	103K00000X	Behavior Analyst

General Provider Information

NPI Number	:	1942049705
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DOUBLECARE ABA GA LLC

Provider Business Mailing Address
First Line	:	1201 W PEACHTREE ST NW
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30309-3449
Country	:	US
Telephone Number	:	646-762-1600
Fax Number	:	646-769-1655

Provider Business Practice Location Address
First Line	:	1201 W PEACHTREE ST NW
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30309-3449
Country	:	US
Telephone Number	:	646-762-1600
Fax Number	:	646-769-1655

Authorized Official
Title or Position	:	MANAGER
Name	:	MR. SHIA KLEIN
Credential	:
Telephone Number	:	646-762-1600

Provider Enumeration Date	:	05/22/2024
Last Update Date	:	05/22/2024

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