Individual
MRS. OPHELIA BATES
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
115 BAYWATCH CIR, FAYETTEVILLE, GA 30215-4671
(678) 764-5609
Mailing address
115 BAYWATCH CIR, FAYETTEVILLE, GA 30215-4671
(678) 764-5609
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
MSW004222
GA
Other
Enumeration date
03/21/2019
Last updated
03/21/2019
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