Active NPI
Emberly Von Wadsworth, RBT
- Behavior Technician
- Martinez, GA
National Provider Identifier
1396356903
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Behavior Technician
- License
- RBT-20-131904
- Practice address
- 4143 Columbia Rd Ste B
Martinez, GA 30907-5405 - Phone
- (706) 755-2785
- Fax
- (706) 755-2783
- NPI assigned
- Aug 17, 2020
- Last updated
- Aug 17, 2020
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Behavior Technician | 106S00000X | RBT-20-131904 | CO | Primary |
Addresses
Primary practice location
4143 Columbia Rd Ste B
Martinez, GA 30907-5405
Mailing address
4143 Columbia Rd Ste B
Martinez, GA 30907-5405
Phone (706) 755-2785
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| RBT-20-131904 | CO | MD | Behavior Technician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Live Oak Behavioral Services, LLC | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Behavior Analyst
- Evans, GA
- NPI 1477040244
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1597622400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1597622400000",
"number": "1396356903",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4143 COLUMBIA RD STE B",
"city": "MARTINEZ",
"state": "GA",
"postal_code": "309075405",
"telephone_number": "706-755-2785",
"fax_number": "706-755-2783"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4143 COLUMBIA RD STE B",
"city": "MARTINEZ",
"state": "GA",
"postal_code": "309075405",
"telephone_number": "706-755-2785",
"fax_number": "706-755-2783"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WADSWORTH",
"first_name": "EMBERLY",
"middle_name": "VON",
"credential": "RBT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2020-08-17",
"last_updated": "2020-08-17",
"certification_date": "2020-08-17",
"status": "A"
},
"taxonomies": [
{
"code": "106S00000X",
"taxonomy_group": "",
"desc": "Behavior Technician",
"state": "CO",
"license": "RBT-20-131904",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Martinez, GA
- Quanisha Aliyah Vera, CEO
- Village Collaborative, LLC
- Janet W Vincent, OTRL
- Amanda Catherine Viola-Brooke, LPC
- Mary Ann Meredith Wade, PHARM.D
- Wal-Mart Stores East LP (WalMart Pharmacy 10-5813)
- Walgreen Co (Walgreens #07772)
- Walgreen Co (Rite Aid #11833)
- Walgreen Co (Walgreens #06395)
- Walgreen Co (Walgreens #06394)
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 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.