Individual
WILLIE MAE BERRY PUGH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2013 TEAL COURT, HEPHZIBAH, GA 30815
(706) 790-4961
Mailing address
2013 TEAL CT, HEPHZIBAH, GA 30815-7951
(706) 790-4961
Taxonomy
Speciality
Code
Description
License number
State
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
Primary
—
—
Other
Enumeration date
08/28/2017
Last updated
07/21/2022
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