Julietta Avila Gamboa
Individual provider Active NPI Behavior Technician · Tyrone, GA
NPI 1104639715 · NPPES record last updated Jan 28, 2025
Key facts
- NPI
- 1104639715
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Behavior Technician 106S00000X
- Practice address
- 120 Handley Rd Ste 410
Tyrone, GA 30290-2174 - Phone
- (770) 629-4660
- NPI assigned
- Jan 28, 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 | Yes |
Addresses
Primary practice location
120 Handley Rd Ste 410
Tyrone, GA 30290-2174
Mailing address
251 Mann Rd
Tyrone, GA 30290-1514
Phone (678) 575-5381
Other providers in Tyrone, GA
- Peggy Ann Fitzgerald Murry
- Jessica Flowers
- Sydney Found
- Olivia Chante' Frazier
- G. Scott Williamson O.D., P.C.
- Peyton Garrett
- Gened Psych Associates, LLC
- Genesys Family Practice, Inc.
- Genesys GYN Inc
- Genesys OB/GYN, LLC
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 Jan 28, 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.