Active NPI
Mary Eloise Fort
- Behavior Technician
- Marietta, GA
National Provider Identifier
1336879162
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Behavior Technician
- Practice address
- 1519 Johnson Ferry Rd BLDG 10
Marietta, GA 30062-6409 - Phone
- (866) 465-3203
- NPI assigned
- Jun 14, 2022
- Sex
- Female
- Sole proprietor
- Yes
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 | Primary |
Addresses
Primary practice location
1519 Johnson Ferry Rd BLDG 10
Marietta, GA 30062-6409
Mailing address
Dept. la 22763
Pasadena, CA 91185-2763
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": "1655164800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1655164800000",
"number": "1336879162",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "DEPT. LA 22763",
"city": "PASADENA",
"state": "CA",
"postal_code": "911852763"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1519 JOHNSON FERRY RD BLDG 10",
"city": "MARIETTA",
"state": "GA",
"postal_code": "300626409",
"telephone_number": "866-465-3203"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FORT",
"first_name": "MARY",
"middle_name": "ELOISE",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2022-06-14",
"last_updated": "2022-06-14",
"certification_date": "2022-06-14",
"status": "A"
},
"taxonomies": [
{
"code": "106S00000X",
"taxonomy_group": "",
"desc": "Behavior Technician",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Marietta, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 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.