Active NPI
Hector Lewis Stanback Jr.
- Behavior Technician
- Stone Mountain, GA
National Provider Identifier
1104590009
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Behavior Technician
- License
- 057756024
- Practice address
- 1452 Knights TRL
Stone Mountain, GA 30083-6200 - Phone
- (678) 789-4812
- NPI assigned
- Aug 4, 2021
- Sex
- Male
- Sole proprietor
- Yes
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 | 057756024 | GA | Primary |
Addresses
Primary practice location
1452 Knights TRL
Stone Mountain, GA 30083-6200
Mailing address
1452 Knights TRL
Stone Mountain, GA 30083-6200
Phone (678) 789-4812
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 |
|---|---|---|---|
| 057756024 | GA | MD | Behavior Technician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1628035200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1628035200000",
"number": "1104590009",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1452 KNIGHTS TRL",
"city": "STONE MOUNTAIN",
"state": "GA",
"postal_code": "300836200",
"telephone_number": "678-789-4812"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1452 KNIGHTS TRL",
"city": "STONE MOUNTAIN",
"state": "GA",
"postal_code": "300836200",
"telephone_number": "678-789-4812"
}
],
"practiceLocations": [],
"basic": {
"last_name": "STANBACK",
"first_name": "HECTOR",
"middle_name": "LEWIS",
"name_suffix": "Jr.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2021-08-04",
"last_updated": "2021-08-04",
"certification_date": "2021-08-04",
"status": "A"
},
"taxonomies": [
{
"code": "106S00000X",
"taxonomy_group": "",
"desc": "Behavior Technician",
"state": "GA",
"license": "057756024",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Stone Mountain, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 4, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.