Active NPI
Dereck Kendall Quarles
- Behavior Technician
- Jonesboro, GA
National Provider Identifier
1972199628
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Behavior Technician
- License
- RBT-20-146994
- Practice address
- 2401 Battlecreek Village Dr
Jonesboro, GA 30236-8539 - Phone
- (404) 538-2390
- NPI assigned
- Dec 16, 2020
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Behavior Technician | 106S00000X | RBT-20-146994 | GA | Primary |
Addresses
Primary practice location
2401 Battlecreek Village Dr
Jonesboro, GA 30236-8539
Mailing address
2401 Battlecreek Village Dr
Jonesboro, GA 30236-8539
Phone (404) 538-2390
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
| License | State | Type | Specialty |
|---|---|---|---|
| RBT-20-146994 | GA | MD | Behavior Technician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1608076800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1608076800000",
"number": "1972199628",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2401 BATTLECREEK VILLAGE DR",
"city": "JONESBORO",
"state": "GA",
"postal_code": "302368539",
"telephone_number": "404-538-2390"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2401 BATTLECREEK VILLAGE DR",
"city": "JONESBORO",
"state": "GA",
"postal_code": "302368539",
"telephone_number": "404-538-2390"
}
],
"practiceLocations": [],
"basic": {
"last_name": "QUARLES",
"first_name": "DERECK",
"middle_name": "KENDALL",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2020-12-16",
"last_updated": "2020-12-16",
"certification_date": "2020-12-16",
"status": "A"
},
"taxonomies": [
{
"code": "106S00000X",
"taxonomy_group": "",
"desc": "Behavior Technician",
"state": "GA",
"license": "RBT-20-146994",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Jonesboro, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 16, 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.