Shannon Bravo
Individual provider Active NPI Behavior Technician · Fortson, GA
NPI 1093678062 · NPPES record last updated Dec 6, 2025
Key facts
- NPI
- 1093678062
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Behavior Technician 106S00000X
- License
- 1452515
- Practice address
- 4443 Ga Highway 219
Fortson, GA 31808-4523 - Phone
- (706) 810-0440
- NPI assigned
- Dec 6, 2025
- Sex
- Female
- 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
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Behavior Technician | 106S00000X | 1452515 | Yes |
Addresses
Primary practice location
4443 Ga Highway 219
Fortson, GA 31808-4523
Mailing address
3821 Gray Fox Dr
Columbus, GA 31909-3203
Phone (862) 432-1399
Other providers in Fortson, GA
- Ashley Ahrens
- Judy R Barnett
- Cassandra Body
- Brightside Behavioral Associates, LLC
- Caresouth Hospice, LLC
- Craig Miller Donalson
- Leona Ramsey Dorsey
- Shae Marie Holmes
All providers in Fortson, 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 Dec 6, 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.