Active NPI
Jemima NA Civil
- Behavior Technician
- Tyrone, GA
National Provider Identifier
1083589360
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Behavior Technician
- License
- RBT-25-413139
- Practice address
- 100 Commerce Dr Unit 452
Tyrone, GA 30290-8020 - Phone
- (404) 590-1677
- NPI assigned
- Oct 7, 2025
- Last updated
- Oct 14, 2025
- Sex
- Unspecified or another gender identity
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Behavior Technician | 106S00000X | RBT-25-413139 | GA | Primary |
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
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| RBT-25-413139 | GA | MD | Behavior Technician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1759795200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1760400000000",
"number": "1083589360",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "700 CARRIAGE LN",
"city": "LAWRENCEVILLE",
"state": "GA",
"postal_code": "300463122",
"telephone_number": "404-590-1677"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "100 COMMERCE DR UNIT 452",
"city": "TYRONE",
"state": "GA",
"postal_code": "302908020",
"telephone_number": "404-590-1677"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CIVIL",
"first_name": "JEMIMA",
"middle_name": "NA",
"sole_proprietor": "NO",
"sex": "X",
"enumeration_date": "2025-10-07",
"last_updated": "2025-10-14",
"certification_date": "2025-10-14",
"status": "A"
},
"taxonomies": [
{
"code": "106S00000X",
"taxonomy_group": "",
"desc": "Behavior Technician",
"state": "GA",
"license": "RBT-25-413139",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Tyrone, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 14, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.