Emily Rose Bolt, MS, BCBA

Primary specialty

Behavior AnalystTaxonomy code 103K00000X

License

1-19-35273 Issued in GA

Practice address

4000 Smithtown Rd Ste 200
Suwanee, GA 30024-6560

Phone

(470) 632-4990

Fax

(317) 520-8200

NPI assigned

Apr 5, 2019

Sex

Female

Sole proprietor

No

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Science

• Emily Rose Duncan Former name

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Aug 24, 2020.

{
    "created_epoch": "1554422400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1598227200000",
    "number": "1912469131",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "300 INTERNATIONAL PKWY STE 200",
            "city": "LAKE MARY",
            "state": "FL",
            "postal_code": "327465028"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4000 SMITHTOWN RD STE 200",
            "city": "SUWANEE",
            "state": "GA",
            "postal_code": "300246560",
            "telephone_number": "470-632-4990",
            "fax_number": "317-520-8200"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOLT",
        "first_name": "EMILY",
        "middle_name": "ROSE",
        "credential": "MS, BCBA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-04-05",
        "last_updated": "2020-08-24",
        "certification_date": "2020-08-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103K00000X",
            "taxonomy_group": "",
            "desc": "Behavior Analyst",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103K00000X",
            "taxonomy_group": "",
            "desc": "Behavior Analyst",
            "state": "GA",
            "license": "1-19-35273",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "EMILY",
            "last_name": "DUNCAN",
            "middle_name": "ROSE",
            "credential": "MS, BCBA",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

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• All providers in Suwanee, GA
• Behavior Analyst in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 24, 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.