Mattavia Smalls

Primary specialty

Behavior AnalystTaxonomy code 103K00000X

License

1-21-51736 Issued in GA

Practice address

209 7TH St
Augusta, GA 30901-1486

Phone

(706) 842-5330

Fax

(706) 842-5340

NPI assigned

Jul 5, 2018

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other names 1

• Mattavia Blackwell Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1530748800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1722297600000",
    "number": "1689160392",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "209 7TH ST FL 3",
            "city": "AUGUSTA",
            "state": "GA",
            "postal_code": "309011486",
            "telephone_number": "706-842-5330",
            "fax_number": "706-842-5340"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "209 7TH ST",
            "city": "AUGUSTA",
            "state": "GA",
            "postal_code": "309011486",
            "telephone_number": "706-842-5330",
            "fax_number": "706-842-5340"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "601 Insperon Dr",
            "address_purpose": "LOCATION",
            "city": "Grovetown",
            "state": "GA",
            "postal_code": "308130609",
            "country_code": "US",
            "telephone_number": "706-842-5330",
            "fax_number": "706-842-5340",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "4210 Columbia Rd Bldg 9",
            "address_purpose": "LOCATION",
            "city": "Martinez",
            "state": "GA",
            "postal_code": "309070401",
            "country_code": "US",
            "telephone_number": "706-842-5330",
            "fax_number": "706-842-5340",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "101 Rossmore Pl",
            "address_purpose": "LOCATION",
            "city": "Augusta",
            "state": "GA",
            "postal_code": "309095771",
            "country_code": "US",
            "telephone_number": "706-842-5330",
            "fax_number": "706-842-5340",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "3727 Executive Center Dr",
            "address_purpose": "LOCATION",
            "city": "Augusta",
            "state": "GA",
            "postal_code": "309072398",
            "country_code": "US",
            "telephone_number": "706-842-5330",
            "fax_number": "706-842-5340",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "7013 Evans Town Center Blvd",
            "address_purpose": "LOCATION",
            "city": "Evans",
            "state": "GA",
            "postal_code": "308095117",
            "country_code": "US",
            "telephone_number": "706-842-5330",
            "fax_number": "706-842-5340",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SMALLS",
        "first_name": "MATTAVIA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-07-05",
        "last_updated": "2024-07-30",
        "certification_date": "2024-07-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106S00000X",
            "taxonomy_group": "",
            "desc": "Behavior Technician",
            "state": "SC",
            "license": "RBT-17-34572",
            "primary": false
        },
        {
            "code": "103K00000X",
            "taxonomy_group": "",
            "desc": "Behavior Analyst",
            "state": "GA",
            "license": "1-21-51736",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MATTAVIA",
            "last_name": "BLACKWELL",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Mikayla Sloan
• Mary Louise Slullivan, R.D., LD, MA
• Tyrone Small, LMSW
• Alexis Vontice Smalley
• Kathleen Smallidge, MS, OTR/L
• Reven C Smalls, LPC
• Donald Lance Smallwood, D.O.
• Brandon Smart
• Smile Center of Augusta, LLC
• Rebecca Smith-Pattillo, P.T.

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 30, 2024; 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.