Individual
DUSTIN STAGGS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
5 CROSS RD, ETHRIDGE, TN 38456-5050
(185) 583-2672
Mailing address
5 CROSS RD, ETHRIDGE, TN 38456-5050
(185) 583-2672
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
23-255761
TN
Other
Enumeration date
03/29/2023
Last updated
03/29/2023
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