Individual provider Active NPI

Raijheen Troy Edwards

  • Behavior Technician
  • Marietta, GA
National Provider Identifier
1770109696
Registry record updated Dec 3, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Behavior TechnicianTaxonomy code 106S00000X
License
RBT-20-111900 Issued in GA
Practice address
1511 Johnson Ferry Rd Ste 145
Marietta, GA 30062-6403
Phone
(404) 480-3842
Fax
(615) 815-1946
NPI assigned
Jun 17, 2020
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 3, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Behavior Technician 106S00000X RBT-20-111900 GA Primary

Addresses

Primary practice location

1511 Johnson Ferry Rd Ste 145
Marietta, GA 30062-6403

Mailing address

1321 Murfreesboro Pike Ste 702
Nashville, TN 37217-2679
Phone (844) 359-7629

Other practice location 1

2651 Dallas Hwy SW
Marietta, GA 30064-2541
Phone (678) 486-1904

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

LicenseStateTypeSpecialty
RBT-20-111900GAMDBehavior Technician

NPI Registry JSON

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

{
    "created_epoch": "1592352000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1606953600000",
    "number": "1770109696",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1321 MURFREESBORO PIKE STE 702",
            "city": "NASHVILLE",
            "state": "TN",
            "postal_code": "372172679",
            "telephone_number": "844-359-7629",
            "fax_number": "615-815-1946"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1511 JOHNSON FERRY RD STE 145",
            "city": "MARIETTA",
            "state": "GA",
            "postal_code": "300626403",
            "telephone_number": "404-480-3842",
            "fax_number": "615-815-1946"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2651 Dallas Hwy SW",
            "address_purpose": "LOCATION",
            "city": "Marietta",
            "state": "GA",
            "postal_code": "300642541",
            "country_code": "US",
            "telephone_number": "678-486-1904",
            "fax_number": "317-520-8200",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "EDWARDS",
        "first_name": "RAIJHEEN",
        "middle_name": "TROY",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-06-17",
        "last_updated": "2020-12-03",
        "certification_date": "2020-12-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106S00000X",
            "taxonomy_group": "",
            "desc": "Behavior Technician",
            "state": "GA",
            "license": "RBT-20-111900",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Marietta, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 3, 2020; 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.