1992074702 NPI number — MRS. JULIE ESHLEMAN M. ED., BCBA

Table of content: MRS. JULIE ESHLEMAN M. ED., BCBA (NPI 1992074702)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1992074702 NPI number — MRS. JULIE ESHLEMAN M. ED., BCBA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ESHLEMAN
Provider First Name:
JULIE
Provider Middle Name:
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
M. ED., BCBA
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
TAYLOR
Provider Other First Name:
JULIE
Provider Other Middle Name:
ELIZABETH
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
M. ED., BCBA
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1992074702
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/10/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3400 MALONE DR UNIT 119
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHAMBLEE
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30341-2706
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
404-721-3275
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3400 MALONE DR UNIT 119
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHAMBLEE
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30341-2706
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
404-721-3275
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/22/2011

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 103K00000X , with the licence number:  1-10-7867 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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