Individual
ELISHA SEWELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
5072 LAVISTA RD, TUCKER, GA 30084-3500
(706) 842-5330
(706) 842-5340
Mailing address
3736 EXECUTIVE CENTER DR, AUGUSTA, GA 30907-2360
(706) 842-5330
(706) 842-5340
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
RBT-22-211880
GA
Other
Enumeration date
04/14/2022
Last updated
04/14/2022
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