Individual
AVIAN MILDREE CRAFT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
912 LOVVORN RD APT 1131, CARROLLTON, GA 30117-2648
(706) 436-9630
Mailing address
912 LOVVORN RD, CARROLLTON, GA 30117-2635
(706) 436-9630
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
106S00000X
BEHAVIOR TECHNICIAN
GA
Enumeration date
02/06/2023
Last updated
02/06/2023
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