Individual
KELLER STREET
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1920 BRIARCLIFF RD NE, ATLANTA, GA 30329-4010
(404) 785-9350
Mailing address
1105 TAYLOR OAKS DR, ROSWELL, GA 30076-1187
(770) 883-9225
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
—
—
Other
Enumeration date
02/02/2022
Last updated
02/02/2022
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