Active NPI
Evan Alexander Holt
- Behavior Technician
- Stone Mountain, GA
National Provider Identifier
1124798137
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Behavior Technician
- Practice address
- 549 Windchase LN
Stone Mountain, GA 30083-6322 - Phone
- (404) 680-5231
- NPI assigned
- Sep 20, 2021
- Last updated
- Sep 20, 2021
- Sex
- Male
- 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 | GA | Primary |
Addresses
Primary practice location
549 Windchase LN
Stone Mountain, GA 30083-6322
Mailing address
549 Windchase LN
Stone Mountain, GA 30083-6322
Phone (404) 680-5231
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 106S00000X | Other | TAXONOMY |
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
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1632096000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1632096000000",
"number": "1124798137",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "549 WINDCHASE LN",
"city": "STONE MOUNTAIN",
"state": "GA",
"postal_code": "300836322",
"telephone_number": "404-680-5231"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "549 WINDCHASE LN",
"city": "STONE MOUNTAIN",
"state": "GA",
"postal_code": "300836322",
"telephone_number": "404-680-5231"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HOLT",
"first_name": "EVAN",
"middle_name": "ALEXANDER",
"name_prefix": "Mr.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2021-09-20",
"last_updated": "2021-09-20",
"certification_date": "2021-09-20",
"status": "A"
},
"taxonomies": [
{
"code": "106S00000X",
"taxonomy_group": "",
"desc": "Behavior Technician",
"state": "GA",
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "TAXONOMY",
"identifier": "106S00000X",
"state": null
}
],
"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 Sep 20, 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.