Individual
MR. ROBERT DENNIS JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
608 HARDEMAN AVE, FORT VALLEY, GA 31030-3438
(478) 957-8447
Mailing address
608 HARDEMAN AVE, FORT VALLEY, GA 31030-3438
(478) 957-8447
Taxonomy
Speciality
Code
Description
License number
State
101YP1600X
Pastoral Counselor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
222116373732
—
GA
01
—
84-1880551
IRS
GA
Enumeration date
05/24/2019
Last updated
05/24/2019
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