Drew Koletsky

Primary specialty

Behavior AnalystTaxonomy code 103K00000X

License

1-21-47760 Issued in GA

Practice address

382 Racetrack Rd Ste 102
McDonough, GA 30252-1022

Phone

(678) 691-2206

NPI assigned

Oct 10, 2014

Last updated

Mar 22, 2021By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

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

{
    "created_epoch": "1412899200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1616371200000",
    "number": "1437553096",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3450 ROXBORO RD NE APT 2401",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303261686",
            "telephone_number": "561-901-8717"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "382 RACETRACK RD STE 102",
            "city": "MCDONOUGH",
            "state": "GA",
            "postal_code": "302521022",
            "telephone_number": "678-691-2206"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KOLETSKY",
        "first_name": "DREW",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2014-10-10",
        "last_updated": "2021-03-22",
        "certification_date": "2021-03-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103K00000X",
            "taxonomy_group": "",
            "desc": "Behavior Analyst",
            "state": "GA",
            "license": "1-21-47760",
            "primary": true
        },
        {
            "code": "222Q00000X",
            "taxonomy_group": "",
            "desc": "Developmental Therapist",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Behavior Analyst in McDonough, GA
• Providers in McDonough, GA by specialty
• Behavior Analyst in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 22, 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.

Verify at the official NPI Registry.