Individual
MAVIS FARMER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1860 PENNSYLVANIA AVE, MCDONOUGH, GA 30253-9117
(678) 462-1342
(678) 493-9464
Mailing address
709 CRESCENT CIR, CANTON, GA 30115-4772
(678) 462-1342
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
001844
GA
Other
Enumeration date
03/05/2013
Last updated
03/05/2013
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