Provider Demographics
NPI:1003469420
Name:BY YOUR SIDE GEORGIA, LLC
Entity type:Organization
Organization Name:BY YOUR SIDE GEORGIA, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:
Authorized Official - Last Name:SULLIVAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-884-1050
Mailing Address - Street 1:3070 BUSINESS PARK DR STE B
Mailing Address - Street 2:
Mailing Address - City:NORCROSS
Mailing Address - State:GA
Mailing Address - Zip Code:30071-1428
Mailing Address - Country:US
Mailing Address - Phone:770-884-1050
Mailing Address - Fax:770-884-1051
Practice Address - Street 1:3070 BUSINESS PARK DR STE B
Practice Address - Street 2:
Practice Address - City:NORCROSS
Practice Address - State:GA
Practice Address - Zip Code:30071-1428
Practice Address - Country:US
Practice Address - Phone:770-884-1050
Practice Address - Fax:770-884-1051
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BY YOUR SIDE LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-07-24
Last Update Date:2020-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty