Individual
ANDISHEH FATHE-AAZAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
BCABA
Contact information
Practice address
229 HIGHWAY 41 N, BARNESVILLE, GA 30204-3209
(888) 963-2228
Mailing address
39 JA ANN DR, THOMASTON, GA 30286-3925
(831) 201-8774
Taxonomy
Speciality
Code
Description
License number
State
106E00000X
Assistant Behavior Analyst
Primary
0-25-16285
GA
Other
Enumeration date
11/09/2022
Last updated
10/01/2025
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