Individual
EARL L BANKSTON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
805 WATERFORD CLUB DR, LITHIA SPRINGS, GA 30122-2673
(678) 593-8205
Mailing address
3294 GA-5, DOUGLASVILLE, GA 30135
(470) 870-2962
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
—
—
Other
Enumeration date
12/08/2022
Last updated
12/08/2022
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