Nicole Surla, BCABA

Primary specialty

Behavior AnalystTaxonomy code 103K00000X

License

0-20-11349 Issued in GA

Practice address

1780 Oak Rd
Snellville, GA 30078-2202

Phone

(678) 691-6797

Fax

(678) 302-3453

NPI assigned

Nov 17, 2020

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

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

{
    "created_epoch": "1605571200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1605571200000",
    "number": "1194328856",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3119 RENAISSANCE WAY NE",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303082463",
            "telephone_number": "912-223-8200"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1780 OAK RD",
            "city": "SNELLVILLE",
            "state": "GA",
            "postal_code": "300782202",
            "telephone_number": "678-691-6797",
            "fax_number": "678-302-3453"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SURLA",
        "first_name": "NICOLE",
        "credential": "BCABA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2020-11-17",
        "last_updated": "2020-11-17",
        "certification_date": "2020-11-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103K00000X",
            "taxonomy_group": "",
            "desc": "Behavior Analyst",
            "state": "GA",
            "license": "0-20-11349",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Behavior Analyst in Snellville, GA
• Providers in Snellville, GA by specialty
• Behavior Analyst in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 17, 2020; 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.