Individual
EMANUEL MALIK ANDERSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
410 E CHURCH ST, FORT VALLEY, GA 31030-3097
(478) 825-6499
Mailing address
410 E CHURCH ST, FORT VALLEY, GA 31030-3097
(478) 825-6499
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Enumeration date
02/07/2020
Last updated
02/07/2020
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