Provider Demographics
NPI:1578048385
Name:NORTH GEORGIA AUTISM CENTER LLC.
Entity Type:Organization
Organization Name:NORTH GEORGIA AUTISM CENTER LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:BETHANY
Authorized Official - Middle Name:DANIELLE
Authorized Official - Last Name:OLIVER CRAIG
Authorized Official - Suffix:
Authorized Official - Credentials:MED, BCBA
Authorized Official - Phone:765-414-6227
Mailing Address - Street 1:9940 HIGHWAY 92
Mailing Address - Street 2:
Mailing Address - City:WOODSTOCK
Mailing Address - State:GA
Mailing Address - Zip Code:30188-6417
Mailing Address - Country:US
Mailing Address - Phone:765-414-6227
Mailing Address - Fax:888-979-8504
Practice Address - Street 1:9940 HIGHWAY 92
Practice Address - Street 2:
Practice Address - City:WOODSTOCK
Practice Address - State:GA
Practice Address - Zip Code:30188-6417
Practice Address - Country:US
Practice Address - Phone:765-414-6227
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-27
Last Update Date:2022-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003216615AMedicaid