Individual
DARCI DEBAUN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
P.T.
Contact information
Practice address
318 W PIKE ST, SUITE 104, LAWRENCEVILLE, GA 30045-3234
(678) 377-2833
(678) 377-2882
Mailing address
3391 SHORELAKE DR, TUCKER, GA 30084-1279
(770) 270-1479
Taxonomy
Speciality
Code
Description
License number
State
2251P0200X
Pediatric Physical Therapist
2001017942
MO
2251P0200X
Pediatric Physical Therapist
Primary
PT007355
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
10037623
AMERIGROUP #
GA
01
—
307936
WELLCARE #
GA
Enumeration date
01/02/2007
Last updated
07/09/2007
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