Active NPI
Ariel Kaitlyn Petrakovich
- Behavior Analyst
- Alpharetta, GA
National Provider Identifier
1275006652
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Behavior Analyst
- License
- 1-19-38197
- Practice address
- 6505 Shiloh Road
Suite 100
Alpharetta, GA 30005 - Phone
- (770) 754-0085
- Fax
- (770) 754-9288
- NPI assigned
- Jan 8, 2019
- Reactivated
- Oct 3, 2019
- Last updated
- Oct 3, 2019
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Behavior Analyst | 103K00000X | 1-19-38197 | NU | Primary |
| Behavior Technician | 106S00000X | NU |
Addresses
Primary practice location
6505 Shiloh Road
Suite 100
Alpharetta, GA 30005
Mailing address
6505 Shiloh Road
Suite 100
Alpharetta, GA 30005
Phone (770) 754-0085
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
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Let's Learn Inc | Behavior Analyst | Past | Accepting new patients |
| Georgia Developmental Services | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
dba Children's Therapy Works
- Pediatric Occupational Therapist
- Roswell, GA
- NPI 1316223142
-
- Behavior Analyst
- Roswell, GA
- NPI 1124569140
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1546905600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1570060800000",
"number": "1275006652",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6505 SHILOH ROAD",
"address_2": "SUITE 100",
"city": "ALPHARETTA",
"state": "GA",
"postal_code": "30005",
"telephone_number": "770-754-0085",
"fax_number": "770-754-9288"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6505 SHILOH ROAD",
"address_2": "SUITE 100",
"city": "ALPHARETTA",
"state": "GA",
"postal_code": "30005",
"telephone_number": "770-754-0085",
"fax_number": "770-754-9288"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PETRAKOVICH",
"first_name": "ARIEL",
"middle_name": "KAITLYN",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2019-01-08",
"last_updated": "2019-10-03",
"deactivation_date": "2019-09-23",
"reactivation_date": "2019-10-03",
"status": "A"
},
"taxonomies": [
{
"code": "103K00000X",
"taxonomy_group": "",
"desc": "Behavior Analyst",
"state": "NU",
"license": "1-19-38197",
"primary": true
},
{
"code": "106S00000X",
"taxonomy_group": "",
"desc": "Behavior Technician",
"state": "NU",
"license": null,
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Alpharetta, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 3, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.