Provider Demographics
NPI:1447877634
Name:EVERITT, CURTIS LOGAN (BCABA)
Entity type:Individual
Prefix:
First Name:CURTIS
Middle Name:LOGAN
Last Name:EVERITT
Suffix:
Gender:M
Credentials:BCABA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5050 RESEARCH CT STE 125
Mailing Address - Street 2:
Mailing Address - City:SUWANEE
Mailing Address - State:GA
Mailing Address - Zip Code:30024-5573
Mailing Address - Country:US
Mailing Address - Phone:404-410-7600
Mailing Address - Fax:
Practice Address - Street 1:1230 JOHNSON FERRY PL STE B10
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30068-2044
Practice Address - Country:US
Practice Address - Phone:404-410-7600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-03
Last Update Date:2023-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARBT-20-125318106S00000X
GA0-23-14593106E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician