Individual
BENJAMIN TYLER FOWLER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
820 DUKE AVE STE A, WARNER ROBINS, GA 31093-2684
(478) 225-3882
Mailing address
1321 MURFREESBORO PIKE STE 702, NASHVILLE, TN 37217-2679
(615) 361-4000
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
RBT-22-202611
VA
Other
Enumeration date
05/24/2022
Last updated
06/01/2022
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