Individual
ANTHONY DWAIN PETTUS JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
100 SPENRYN DR, MADISON, AL 35758-1890
(256) 772-4400
Mailing address
100 SPENRYN DR, MADISON, AL 35758-1890
(256) 772-4400
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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