| Fusion Autism Center | |
|
105 Grand Central Blvd Ste 101 Pooler GA 31322-4146 | |
| (866) 610-0580 | |
| Not Available |
| Full Name | Fusion Autism Center |
|---|---|
| Speciality | Behavior Analyst |
| Location | 105 Grand Central Blvd Ste 101, Pooler, Georgia |
| Authorized Official Name and Position | Jason Owen (CEO) |
| Authorized Official Contact | 4708166449 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Fusion Autism Center 300 International Pkwy Ste 200 Lake Mary FL 32746-5028 Ph: (866) 610-0580 | Fusion Autism Center 105 Grand Central Blvd Ste 101 Pooler GA 31322-4146 Ph: (866) 610-0580 |
| NPI Number | 1245862119 |
|---|---|
| Provider Enumeration Date | 02/10/2020 |
| Last Update Date | 11/07/2022 |
| Certification Date | 11/07/2022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1245862119 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103K00000X | Behavior Analyst | () | Primary |
| 106E00000X | Assistant Behavior Analyst | () | Secondary |
| 106S00000X | Behavior Technician | () | Secondary |
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