Individual provider Active NPI

Jerica Clark-Wilborn

  • Behavior Technician
  • Evans, GA
National Provider Identifier
1801764972
Registry record updated Feb 16, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Behavior TechnicianTaxonomy code 106S00000X
License
RBT-25-485968 Issued in GA
Practice address
478 Columbia Industrial Blvd
Evans, GA 30809-6127
Phone
(706) 437-0505
Fax
(706) 437-0505
NPI assigned
Oct 29, 2025
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 16, 2026

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-25-485968 GA Primary

Addresses

Primary practice location

478 Columbia Industrial Blvd
Evans, GA 30809-6127

Mailing address

PO Box 14067
Augusta, GA 30919-0067
Phone (706) 437-0505

Other practice location 1

727 W 6th St
Waynesboro, GA 30830-4407
Phone (706) 437-0505 ext. 1

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-25-485968GAMDBehavior Technician

Practice roles

OrganizationSpecialtyStatusNew patients
Center New Beginnings CurrentSince Nov 8, 2025 Accepting new patients
Center New Beginnings PastSince Nov 8, 2025 Accepting new patients

Locations

478 Columbia Industrial Blvd
Evans, GA 30809
Phone (706) 437-0505

Organizations & group practices 2

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": "1761696000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1771200000000",
    "number": "1801764972",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 14067",
            "city": "AUGUSTA",
            "state": "GA",
            "postal_code": "309190067",
            "telephone_number": "706-437-0505",
            "fax_number": "706-554-6219"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "478 COLUMBIA INDUSTRIAL BLVD",
            "city": "EVANS",
            "state": "GA",
            "postal_code": "308096127",
            "telephone_number": "706-437-0505",
            "fax_number": "706-437-0505"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "727 W 6th St",
            "address_purpose": "LOCATION",
            "city": "Waynesboro",
            "state": "GA",
            "postal_code": "308304407",
            "country_code": "US",
            "telephone_number": "706-437-0505 x1",
            "fax_number": "706-554-6219",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CLARK-WILBORN",
        "first_name": "JERICA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2025-10-29",
        "last_updated": "2026-02-16",
        "certification_date": "2026-02-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106S00000X",
            "taxonomy_group": "",
            "desc": "Behavior Technician",
            "state": "GA",
            "license": "RBT-25-485968",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Evans, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 16, 2026; 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.