Provider Demographics
NPI:1689118473
Name:BEAUREGARD, GEORGIA (BCBA)
Entity Type:Individual
Prefix:
First Name:GEORGIA
Middle Name:
Last Name:BEAUREGARD
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1435 MERIDIAN ST SE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30317-1725
Mailing Address - Country:US
Mailing Address - Phone:770-268-3909
Mailing Address - Fax:
Practice Address - Street 1:1435 MERIDIAN ST SE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30317-1725
Practice Address - Country:US
Practice Address - Phone:770-268-3909
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-13
Last Update Date:2024-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA1-16-23698103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst