Individual
BENJAMIN TYLER FOWLER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
BCBA
Contact information
Practice address
311 MARGIE DR, WARNER ROBINS, GA 31088-7818
(404) 410-7600
Mailing address
5050 RESEARCH CT STE 125, SUWANEE, GA 30024-5573
(404) 410-7600
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
1-26-90082
GA
106S00000X
Behavior Technician
Primary
RBT-22-202611
VA
Other
Enumeration date
05/24/2022
Last updated
05/22/2026
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