Individual
DERRICK GAUSE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
2401 BUENA VISTA RD, COLUMBUS, GA 31906-3142
(706) 323-7244
Mailing address
2401 BUENA VISTA RD, COLUMBUS, GA 31906-3142
Taxonomy
Speciality
Code
Description
License number
State
251C00000X
Developmentally Disabled Services Day Training Agency
Primary
—
—
Other
Enumeration date
12/21/2017
Last updated
12/21/2017
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