Individual
BRANDON BOGUES
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
122 GORDON COMMERCIAL DR STE C, LAGRANGE, GA 30240-5754
(770) 836-6678
Mailing address
122 GORDON COMMERCIAL DR STE C, LAGRANGE, GA 30240-5754
(770) 836-6678
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Enumeration date
04/30/2018
Last updated
04/30/2018
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