NPIMap

Organization Active NPI

Supportive Care ABA Ga LLC

  • Behavior Analyst
  • Newnan, GA
National Provider Identifier
1023731320
Registry record updated Sep 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Behavior AnalystTaxonomy code 103K00000X
Legal business name
SUPPORTIVE CARE ABA GA LLC
Practice address
15 Perry St Ste 404
Newnan, GA 30263-1918
Phone
(317) 936-1240
Fax
(317) 936-1241
NPI assigned
Sep 21, 2022
Last updated
Sep 21, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 21, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. Ruben Kesherim
Title
Member
Phone
(317) 936-1240

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Behavior Analyst 103K00000X Primary

Addresses

Primary practice location

15 Perry St Ste 404
Newnan, GA 30263-1918

Mailing address

15 Perry St Ste 404
Newnan, GA 30263-1918
Phone (317) 936-1240

National Provider Directory

National Provider Directory

Locations

15 Perry St
Ste 404
Newnan, GA 30263

15 Perry St
Unit 404
Newnan, GA 30263

Practitioners & affiliated clinicians

Practitioners 16

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 16

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1663718400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1663718400000",
    "number": "1023731320",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15 PERRY ST STE 404",
            "city": "NEWNAN",
            "state": "GA",
            "postal_code": "302631918",
            "telephone_number": "317-936-1240",
            "fax_number": "317-936-1241"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15 PERRY ST STE 404",
            "city": "NEWNAN",
            "state": "GA",
            "postal_code": "302631918",
            "telephone_number": "317-936-1240",
            "fax_number": "317-936-1241"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SUPPORTIVE CARE ABA GA LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-09-21",
        "last_updated": "2022-09-21",
        "certification_date": "2022-09-21",
        "status": "A",
        "authorized_official_last_name": "KESHERIM",
        "authorized_official_first_name": "RUBEN",
        "authorized_official_title_or_position": "MEMBER",
        "authorized_official_telephone_number": "317-936-1240",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "103K00000X",
            "taxonomy_group": "",
            "desc": "Behavior Analyst",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Newnan, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.