Individual
ELIZABETH E TIDEY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
5163 ROSWELL RD, ATLANTA, GA 30342-2206
(877) 288-4760
Mailing address
69 ROSWELL CT NE, ATLANTA, GA 30305-1411
(863) 279-8100
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Enumeration date
07/05/2023
Last updated
07/05/2023
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