Jemima NA Civil
Individual provider Active NPI Behavior Technician · Tyrone, GA
NPI 1083589360 · NPPES record last updated Oct 14, 2025
Key facts
- NPI
- 1083589360
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Behavior Technician 106S00000X
- License
- RBT-25-413139 (GA)
- Practice address
- 100 Commerce Dr Unit 452
Tyrone, GA 30290-8020 - Phone
- (404) 590-1677
- NPI assigned
- Oct 7, 2025
- Sex
- Unspecified or another gender identity
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| RBT-25-413139 | GA | MD | Behavior Technician |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Behavior Technician | 106S00000X | RBT-25-413139 | GA | Yes |
Addresses
Primary practice location
100 Commerce Dr Unit 452
Tyrone, GA 30290-8020
Mailing address
700 Carriage LN
Lawrenceville, GA 30046-3122
Phone (404) 590-1677
Other providers in Tyrone, GA
- Shohna Castellanos
- Charisse L. Caswell
- Center for Family Psychiatry
- Anna Taylor Chapman
- Madison Scott Chase
- Ashley Danielle Clay
- Gabrielle Cobb
- Dawn M Coffman
- Seth Lee Cohen
- Julian Coleman
All providers in Tyrone, GA · Behavior Technician in Georgia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 14, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.