Individual
MR. JAKARTA AGNEW
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
139 E OLD TRENTON RD STE B, CLARKSVILLE, TN 37043-5945
(931) 444-1449
Mailing address
139 E OLD TRENTON RD STE B, CLARKSVILLE, TN 37043-5945
(931) 444-1449
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Enumeration date
03/14/2022
Last updated
03/14/2022
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