NPIMap

Organization Active NPI

Qillawasi LLC

Doing business as Success On The Spectrum

  • Behavior Analyst
  • Tucker, GA
National Provider Identifier
1467108035
Registry record updated Feb 23, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Behavior AnalystTaxonomy code 103K00000X
Legal business name
QILLAWASI LLC
Doing business as
Success On The Spectrum
Practice address
2043 Weems Rd.
Suite C2043
Tucker, GA 30084
Phone
(470) 658-9610
NPI assigned
Feb 23, 2022
Last updated
Feb 23, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 23, 2022

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

Authorized official

Name
Andres Dargent
Title
Ceo
Phone
(470) 658-9610

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Behavior AnalystGroup: 193200000X MULTI-SPECIALTY GROUP 103K00000X Primary
Community/Behavioral Health Agency 251S00000X
Hearing and Speech Clinic/Center 261QH0700X
Occupational Medicine Clinic/Center 261QX0100X

Addresses

Primary practice location

2043 Weems Rd.
Suite C2043
Tucker, GA 30084

Mailing address

2440 Circlewood Rd NE
Atlanta, GA 30345-1950
Phone (470) 658-9610

Other names 1

  • Success On The Spectrum Doing business as

National Provider Directory

National Provider Directory

Locations

2044 Weems Rd
#A
Tucker, GA 30084
Phone (470) 207-5604

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1645574400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1645574400000",
    "number": "1467108035",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2440 CIRCLEWOOD RD NE",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303451950",
            "telephone_number": "470-658-9610"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2043 WEEMS RD.",
            "address_2": "SUITE C2043",
            "city": "TUCKER",
            "state": "GA",
            "postal_code": "30084",
            "telephone_number": "470-658-9610"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "QILLAWASI LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-02-23",
        "last_updated": "2022-02-23",
        "certification_date": "2022-02-09",
        "status": "A",
        "authorized_official_last_name": "DARGENT",
        "authorized_official_first_name": "ANDRES",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "470-658-9610"
    },
    "taxonomies": [
        {
            "code": "103K00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Behavior Analyst",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QH0700X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Hearing and Speech",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QX0100X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Occupational Medicine",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Success On The Spectrum",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Tucker, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 23, 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.

Verify at the official NPI Registry.