Individual
OCTAVIA HEAD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RBT
Contact information
Practice address
382 RACETRACK RD, MCDONOUGH, GA 30252-1022
(678) 691-2206
Mailing address
754 PINE NEEDLE RD, HAMPTON, GA 30228-1544
(404) 957-1698
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
—
—
Other
Enumeration date
12/08/2020
Last updated
12/08/2020
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