Individual
MR. CHARLES CONRAD FABRIZIO JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
6849 PEACHTREE DUNWOODY RD, SANDY SPRINGS, GA 30328-1608
(678) 691-2206
Mailing address
27 28TH ST NW APT 1, ATLANTA, GA 30309-1867
(215) 317-8274
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
RBT-19-103050
GA
Other
Enumeration date
06/30/2020
Last updated
06/30/2020
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