MEDICARE: RESURGENCE EDUCATIONAL SOLUTIONS, 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	:	1972347953
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RESURGENCE EDUCATIONAL SOLUTIONS, LLC

Provider Business Mailing Address
First Line	:	5829 CAMPBELLTON RD SW STE 104
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30331-8036
Country	:	US
Telephone Number	:	770-940-0237
Fax Number	:	877-940-3221

Provider Business Practice Location Address
First Line	:	334 WOODMILL WAY SW
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30331-8036
Country	:	US
Telephone Number	:	770-940-0237
Fax Number	:	877-940-3221

Authorized Official
Title or Position	:	CHIEF EXECUTIVE OFFICER
Name	:	DR. RIA THERESA ARCHIBALD
Credential	:	BCBA
Telephone Number	:	770-940-0237

Provider Enumeration Date	:	06/24/2024
Last Update Date	:	04/08/2025

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