Individual
BRIAN EZRA BATES
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CADC-I
Contact information
Practice address
2007 OLD LAFAYETTE RD, FORT OGLETHORPE, GA 30742-3510
(706) 861-9390
(706) 866-4740
Mailing address
1770 PIEDMONT LN, CUMMING, GA 30040-9315
(256) 694-0423
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
895
GA
Other
Enumeration date
05/08/2018
Last updated
05/08/2018
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