Individual
ELLIS J WADDELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
RBT
Contact information
Practice address
1110 13TH ST STE D, COLUMBUS, GA 31901-2246
(706) 780-1704
Mailing address
1800 LAKEWOOD DR, PHENIX CITY, AL 36867-1867
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Enumeration date
10/10/2019
Last updated
10/10/2019
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