Provider Demographics
NPI:1932921178
Name:NASH, ROSA LEIGHA MARIE
Entity type:Individual
Prefix:
First Name:ROSA
Middle Name:LEIGHA MARIE
Last Name:NASH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:65 KENDALL LN
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:GA
Mailing Address - Zip Code:30014-8498
Mailing Address - Country:US
Mailing Address - Phone:470-399-8500
Mailing Address - Fax:
Practice Address - Street 1:65 KENDALL LN
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:GA
Practice Address - Zip Code:30014-8498
Practice Address - Country:US
Practice Address - Phone:470-399-8500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-29
Last Update Date:2024-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARBT-24-383196106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician