Individual
ETHAN DANIEL SHUFORD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
100 COMMERCE CT, POOLER, GA 31322-9445
(615) 560-6622
Mailing address
163 19TH AVE NW, HICKORY, NC 28601-1830
(828) 261-6462
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Enumeration date
12/25/2024
Last updated
12/25/2024
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