Active NPI
Phillip Jason Southers, RBT
- Behavior Technician
- Huntsville, AL
National Provider Identifier
1639840754
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Behavior Technician
- License
- RBT-21-174090
- Practice address
- 6125 University Dr NW Ste B22
Huntsville, AL 35806-1765 - Phone
- (256) 692-9262
- Fax
- (888) 392-7185
- NPI assigned
- Sep 28, 2021
- Sex
- Male
- 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-21-174090 | AL | Primary |
Addresses
Primary practice location
6125 University Dr NW Ste B22
Huntsville, AL 35806-1765
Mailing address
415 N Richard Jackson Blvd
Panama City, FL 32407-3664
Phone (850) 866-0441
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-21-174090 | AL | MD | Behavior Technician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1632787200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1632787200000",
"number": "1639840754",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "415 N RICHARD JACKSON BLVD",
"city": "PANAMA CITY",
"state": "FL",
"postal_code": "324073664",
"telephone_number": "850-866-0441",
"fax_number": "850-254-0827"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6125 UNIVERSITY DR NW STE B22",
"city": "HUNTSVILLE",
"state": "AL",
"postal_code": "358061765",
"telephone_number": "256-692-9262",
"fax_number": "888-392-7185"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SOUTHERS",
"first_name": "PHILLIP",
"middle_name": "JASON",
"name_prefix": "Mr.",
"credential": "RBT",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2021-09-28",
"last_updated": "2021-09-28",
"certification_date": "2021-08-04",
"status": "A"
},
"taxonomies": [
{
"code": "106S00000X",
"taxonomy_group": "",
"desc": "Behavior Technician",
"state": "AL",
"license": "RBT-21-174090",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Huntsville, AL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 28, 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.