Individual
IYANU KOFOWORADE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
RBT
Contact information
Practice address
10744 MISTY MEADOWS CT, HAMPTON, GA 30228-6187
(678) 702-3117
Mailing address
10744 MISTY MEADOWS CT, HAMPTON, GA 30228-6187
(678) 702-3117
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
RBT-22-242146
GA
Other
Enumeration date
01/19/2023
Last updated
01/19/2023
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