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EPHESIAN TISDALE

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
RBT

Contact information

Practice address
2387 HUNTCREST WAY, LAWRENCEVILLE, GA 30043-8126
(678) 648-7644
Mailing address
6505 SHILOH RD STE 100, ALPHARETTA, GA 30005-1645
(678) 648-7644
(317) 520-8200

Taxonomy

Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
RBT-22-216818
GA

Other

Enumeration date
05/26/2022
Last updated
05/20/2024
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