Individual provider Active NPI

Nympha J. Mathurin Meadows, M.ED, BCBA

  • Behavior Analyst
  • Johns Creek, GA
National Provider Identifier
1700300795
Registry record updated Jul 27, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Behavior AnalystTaxonomy code 103K00000X
Practice address
11340 Lakefield Dr Ste 200
Johns Creek, GA 30097-2456
Phone
(800) 331-8604
Fax
(800) 331-8604
NPI assigned
Aug 1, 2017
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 27, 2022

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Behavior Technician 106S00000X
Community/Behavioral Health Agency 251S00000X
Behavior Analyst 103K00000X Primary

Addresses

Primary practice location

11340 Lakefield Dr Ste 200
Johns Creek, GA 30097-2456

Mailing address

2100 Riverside Pkwy
Suite 128 - 144
Lawrenceville, GA 30043-5368
Phone (800) 331-8604

Other practice location 1

650 Oxford Crest Ct
Lawrenceville, GA 30043
Phone (786) 541-6212

Other identifiers 2

IdentifierTypeStateIssuer
1700300795MedicaidGA
1205138864MedicaidGA

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
Credentials
Master of Education

Practice roles

OrganizationSpecialtyStatusNew patients
Special Transition Works , LLC Behavior Analyst Current Accepting new patients

Locations

11340 Lakefield Dr
Ste 200
Johns Creek, GA 30097
Phone (678) 407-2159

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1501545600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658880000000",
    "number": "1700300795",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2100 RIVERSIDE PKWY",
            "address_2": "SUITE 128 - 144",
            "city": "LAWRENCEVILLE",
            "state": "GA",
            "postal_code": "300435368",
            "telephone_number": "800-331-8604",
            "fax_number": "800-331-8604"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11340 LAKEFIELD DR STE 200",
            "city": "JOHNS CREEK",
            "state": "GA",
            "postal_code": "300972456",
            "telephone_number": "800-331-8604",
            "fax_number": "800-331-8604"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "650 Oxford Crest Ct",
            "address_purpose": "LOCATION",
            "city": "Lawrenceville",
            "state": "GA",
            "postal_code": "30043",
            "country_code": "US",
            "telephone_number": "786-541-6212",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MATHURIN MEADOWS",
        "first_name": "NYMPHA",
        "middle_name": "J.",
        "name_prefix": "Mrs.",
        "credential": "M.ED, BCBA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2017-08-01",
        "last_updated": "2022-07-27",
        "certification_date": "2022-07-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106S00000X",
            "taxonomy_group": "",
            "desc": "Behavior Technician",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103K00000X",
            "taxonomy_group": "",
            "desc": "Behavior Analyst",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1700300795",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1205138864",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Johns Creek, GA

Sources for this page

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