Tiffany Brook Balli

Primary specialty

Behavior TechnicianTaxonomy code 106S00000X

License

RBT-21-181229 Issued in GA

Practice address

1275 Minhinette Dr
Roswell, GA 30075-7217

Phone

(877) 288-4760

NPI assigned

Aug 20, 2021

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Dogwood Autism Services, LLC

  • Behavior Analyst
  • Atlanta, GA
  • NPI 1437674587
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1629417600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1629417600000",
    "number": "1174299929",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "320 KNOLLWOOD LN",
            "city": "WOODSTOCK",
            "state": "GA",
            "postal_code": "301885372",
            "telephone_number": "404-421-5776"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1275 MINHINETTE DR",
            "city": "ROSWELL",
            "state": "GA",
            "postal_code": "300757217",
            "telephone_number": "877-288-4760"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BALLI",
        "first_name": "TIFFANY",
        "middle_name": "BROOK",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-08-20",
        "last_updated": "2021-08-20",
        "certification_date": "2021-08-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106S00000X",
            "taxonomy_group": "",
            "desc": "Behavior Technician",
            "state": "GA",
            "license": "RBT-21-181229",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Erica Baldwin
• Gwennever Elaine Baldwin, L.M.T.
• Marvin Baldwin Jr.
• Jill M Ballew, CNM
• Sydney Ballew
• Linda A Banik, MA, LPC
• Michelle Bank, M.ED., CCC-SLP
• Cassidy Banks, NP
• David W Banks, MD
• Reya Bansal, DNAP, CRNA

• Behavior Technician in Roswell, GA
• Providers in Roswell, GA by specialty
• Behavior Technician in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 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.

Verify at the official NPI Registry.