Active NPI
Shaneka Rochelle Grant
- Behavior Technician
- Hinesville, GA
National Provider Identifier
1104659606
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Behavior Technician
- License
- RBT-24-351788
- Practice address
- 481 Elma G Miles Pkwy Ste B
Hinesville, GA 31313-4004 - Phone
- (912) 532-9774
- Fax
- (912) 221-3085
- NPI assigned
- Aug 21, 2024
- Sex
- Female
- 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-24-351788 | GA | Primary |
Addresses
Primary practice location
481 Elma G Miles Pkwy Ste B
Hinesville, GA 31313-4004
Mailing address
481 Elma G Miles Pkwy Ste B
Hinesville, GA 31313-4004
Phone (912) 532-9774
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-24-351788 | GA | MD | Behavior Technician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1724198400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1724198400000",
"number": "1104659606",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "481 ELMA G MILES PKWY STE B",
"city": "HINESVILLE",
"state": "GA",
"postal_code": "313134004",
"telephone_number": "912-532-9774",
"fax_number": "912-221-3085"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "481 ELMA G MILES PKWY STE B",
"city": "HINESVILLE",
"state": "GA",
"postal_code": "313134004",
"telephone_number": "912-532-9774",
"fax_number": "912-221-3085"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GRANT",
"first_name": "SHANEKA",
"middle_name": "ROCHELLE",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2024-08-21",
"last_updated": "2024-08-21",
"certification_date": "2024-08-21",
"status": "A"
},
"taxonomies": [
{
"code": "106S00000X",
"taxonomy_group": "",
"desc": "Behavior Technician",
"state": "GA",
"license": "RBT-24-351788",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Hinesville, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 21, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.