Individual
EZRA MAL FRY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
113 GOODSON AVE APT 17, CHATTANOOGA, TN 37405-4720
(828) 400-4478
Mailing address
113 GOODSON AVE APT 17, CHATTANOOGA, TN 37405-4720
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
BACB874454
—
Other
Enumeration date
12/29/2022
Last updated
12/29/2022
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