Tiffany Michele Trautner

Primary specialty

Behavior TechnicianTaxonomy code 106S00000X

License

RBT-16-25686 Issued in GA

Practice address

1135 Senoia Rd
Tyrone, GA 30290-1625

Phone

(770) 626-3044

NPI assigned

Apr 14, 2020

Last updated

Nov 27, 2023By 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 1

Addresses

Other identifiers 1

Electronic endpoints 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

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.

• Southside ABA LLC

  • Behavior Analyst
  • Tyrone, GA
  • NPI 1134759608
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1586822400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1701043200000",
    "number": "1417576992",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1135 SENOIA RD",
            "city": "TYRONE",
            "state": "GA",
            "postal_code": "302901625",
            "telephone_number": "770-626-3044"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1135 SENOIA RD",
            "city": "TYRONE",
            "state": "GA",
            "postal_code": "302901625",
            "telephone_number": "770-626-3044"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TRAUTNER",
        "first_name": "TIFFANY",
        "middle_name": "MICHELE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-04-14",
        "last_updated": "2023-11-27",
        "certification_date": "2020-04-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106S00000X",
            "taxonomy_group": "",
            "desc": "Behavior Technician",
            "state": "GA",
            "license": "RBT-16-25686",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "003218736A",
            "state": "GA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "cmarreo@southsideaba.com",
            "affiliation": "N",
            "address_1": "1135 Senoia Rd",
            "city": "Tyrone",
            "state": "GA",
            "country_code": "US",
            "postal_code": "302901625",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "cmarrero@southsideaba.com",
            "affiliation": "Y",
            "affiliationName": "Southside ABA LLC",
            "address_1": "1135 Senoia Rd",
            "city": "Tyrone",
            "state": "GA",
            "country_code": "US",
            "postal_code": "302901625",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

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• Martha B Trisler, P.T.
• Sonya Nesmith Tucker, LPC
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• Tyrone Podiatry

• Behavior Technician in Tyrone, GA
• Providers in Tyrone, GA by specialty
• Behavior Technician in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 27, 2023; 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.