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Individual
ANTHONY DWAIN PETTUS JR.
Active
Individual
ANTHONY DWAIN PETTUS JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
19-88268
AL
171M00000X
Case Manager/Care Coordinator
—
TN
Other
Enumeration date
02/14/2018
Last updated
06/12/2019
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