Ga Sprout MC 1 LLC

Primary specialty

Behavior AnalystTaxonomy code 103K00000X

Legal business name

GA SPROUT MC 1 LLC

Doing business as

Elemy
Sprout Therapy

Practice address

3455 Peachtree Rd NE FL 5
Atlanta, GA 30326-3254

Phone

(833) 991-2368

Fax

(929) 384-7193

NPI assigned

Apr 8, 2020

Organization subpart

No

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

Authorized official

Name

Yury Yakubchyk Sr.

Title

Owner

Phone

(404) 738-7658

Specialties & licenses 1

Addresses

Other names 2

• Elemy Doing business as
• Sprout Therapy Doing business as

Tax ID family

Crownview Telehealth Instiute LLC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Crownview Telehealth Instiute LLC

  • Community/Behavioral Health Agency
  • Oceanside, CA
  • NPI 1497369987
  NPD tax ID

Locations

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

{
    "created_epoch": "1586304000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1632700800000",
    "number": "1831728039",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3455 PEACHTREE RD NE FL 5",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303263254",
            "telephone_number": "833-991-2368",
            "fax_number": "929-384-7193"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3455 PEACHTREE RD NE FL 5",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303263254",
            "telephone_number": "833-991-2368",
            "fax_number": "929-384-7193"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GA SPROUT MC 1 LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-04-08",
        "last_updated": "2021-09-27",
        "certification_date": "2021-09-27",
        "status": "A",
        "authorized_official_last_name": "YAKUBCHYK",
        "authorized_official_first_name": "YURY",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "404-738-7658",
        "authorized_official_name_suffix": "Sr."
    },
    "taxonomies": [
        {
            "code": "103K00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Behavior Analyst",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Elemy",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Sprout Therapy",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Sprout Therapy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Ga Southern Dental LLC (MidCIty Dentistry)
• Ga Southern Dental LLC (Mallard Cove Dental)
• Ga Southern Dental LLC (Intown Smile Studio)
• Ga Southern Dental PPO (Mallard Cove Dental)
• Ga Southern Dental PPO (Collier Hills Dentistry)
• Ga Wound Care Medical Group
• Trenton Gaasch, O.D.
• Benjamin Thomas Gabanic
• Gabella Brain and Spine Clinic
• Angela Maria Gabella, D.C.

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

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

Verify at the official NPI Registry.