Individual
JACOREY WILDER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
SNELLVILLE GA, SNELLVILLE, GA 30078
(404) 407-5224
Mailing address
1900 TREE MOUNTAIN PKWY # 5304, STONE MOUNTAIN, GA 30083-6711
(561) 932-7248
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
GA
Other
Enumeration date
09/28/2021
Last updated
10/11/2021
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