Active NPI
Ebony Lamyiah Wynn
- Behavior Technician
- Statesboro, GA
National Provider Identifier
1417520792
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Behavior Technician
- Practice address
- 2000 Stambuk LN Apt 1015
Statesboro, GA 30458-0219 - Phone
- (706) 831-2501
- NPI assigned
- Jul 23, 2021
- 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 | GA | Primary |
Addresses
Primary practice location
2000 Stambuk LN Apt 1015
Statesboro, GA 30458-0219
Mailing address
2000 Stambuk LN Apt 1015
Statesboro, GA 30458-0219
Phone (706) 831-2501
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": "1626998400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1626998400000",
"number": "1417520792",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2000 STAMBUK LN APT 1015",
"city": "STATESBORO",
"state": "GA",
"postal_code": "304580219",
"telephone_number": "706-831-2501"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2000 STAMBUK LN APT 1015",
"city": "STATESBORO",
"state": "GA",
"postal_code": "304580219",
"telephone_number": "706-831-2501"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WYNN",
"first_name": "EBONY",
"middle_name": "LAMYIAH",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2021-07-23",
"last_updated": "2021-07-23",
"certification_date": "2021-07-11",
"status": "A"
},
"taxonomies": [
{
"code": "106S00000X",
"taxonomy_group": "",
"desc": "Behavior Technician",
"state": "GA",
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Statesboro, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 23, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.