NPIMap

Organization Active NPI

Creekside Autism Center

  • Behavior Analyst
  • Suwanee, GA
National Provider Identifier
1902687981
Registry record updated Oct 6, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Behavior AnalystTaxonomy code 103K00000X
Legal business name
CREEKSIDE AUTISM CENTER
Practice address
4035 Johns Creek Pkwy Ste B
Suwanee, GA 30024-1213
Phone
(770) 888-5221
Fax
(678) 680-5929
NPI assigned
Oct 6, 2023
Last updated
Oct 6, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 6, 2023

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

Authorized official

Name
Myrlaine Darius
Title
Admin Director
Phone
(770) 888-5221

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Behavior Analyst 103K00000X Primary
Assistant Behavior Analyst 106E00000X
Behavior Technician 106S00000X

Addresses

Primary practice location

4035 Johns Creek Pkwy Ste B
Suwanee, GA 30024-1213

Mailing address

4055 Johns Creek Pkwy Ste a
Suwanee, GA 30024-1299
Phone (770) 888-5221

National Provider Directory

National Provider Directory

Locations

4035 Johns Creek Pkwy
Suwanee, GA 30024

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1696550400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1696550400000",
    "number": "1902687981",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4055 JOHNS CREEK PKWY STE A",
            "city": "SUWANEE",
            "state": "GA",
            "postal_code": "300241299",
            "telephone_number": "770-888-5221",
            "fax_number": "678-680-5929"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4035 JOHNS CREEK PKWY STE B",
            "city": "SUWANEE",
            "state": "GA",
            "postal_code": "300241213",
            "telephone_number": "770-888-5221",
            "fax_number": "678-680-5929"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CREEKSIDE AUTISM CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-10-06",
        "last_updated": "2023-10-06",
        "certification_date": "2023-10-06",
        "status": "A",
        "authorized_official_last_name": "DARIUS",
        "authorized_official_first_name": "MYRLAINE",
        "authorized_official_title_or_position": "ADMIN DIRECTOR",
        "authorized_official_telephone_number": "770-888-5221"
    },
    "taxonomies": [
        {
            "code": "103K00000X",
            "taxonomy_group": "",
            "desc": "Behavior Analyst",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "106E00000X",
            "taxonomy_group": "",
            "desc": "Assistant Behavior Analyst",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "106S00000X",
            "taxonomy_group": "",
            "desc": "Behavior Technician",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Suwanee, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 6, 2023; 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.