Derricka F De Jean

Primary specialty

Behavior AnalystTaxonomy code 103K00000X

License

1-22-62360 Issued in GA

Practice address

1233 Eagle Lndng Pkwy Ste a&B
Stockbridge, GA 30281-6399

Phone

(470) 231-1149

Fax

(615) 815-1946

NPI assigned

Oct 5, 2021

Last updated

Nov 14, 2022By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other names 1

• Derricka F Fortson Former name

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": "1633392000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1668384000000",
    "number": "1265104418",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1321 MURFREESBORO PIKE STE 702",
            "city": "NASHVILLE",
            "state": "TN",
            "postal_code": "372172679",
            "telephone_number": "615-361-4000",
            "fax_number": "615-815-1946"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1233 EAGLE LNDNG PKWY STE A&B",
            "city": "STOCKBRIDGE",
            "state": "GA",
            "postal_code": "302816399",
            "telephone_number": "470-231-1149",
            "fax_number": "615-815-1946"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DE JEAN",
        "first_name": "DERRICKA",
        "middle_name": "F",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-10-05",
        "last_updated": "2022-11-14",
        "certification_date": "2022-11-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103K00000X",
            "taxonomy_group": "",
            "desc": "Behavior Analyst",
            "state": "GA",
            "license": "1-22-62360",
            "primary": true
        },
        {
            "code": "106S00000X",
            "taxonomy_group": "",
            "desc": "Behavior Technician",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "DERRICKA",
            "last_name": "FORTSON",
            "middle_name": "F",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

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• Behavior Analyst in Stockbridge, GA
• Providers in Stockbridge, 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 14, 2022; 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.