Individual
BEZAWIT LIANE BUSAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
3229 S CHEROKEE LN, WOODSTOCK, GA 30188-4461
(470) 499-2480
Mailing address
2121 WINDY HILL RD APT 1529, MARIETTA, GA 30060-6417
(760) 524-2676
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Enumeration date
10/06/2020
Last updated
10/06/2020
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