Individual
BLAIR ALLEN BROUSSARD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
4539 CABINWOOD TURN, DOUGLASVILLE, GA 30135-1959
(470) 832-0704
Mailing address
4539 CABINWOOD TURN, DOUGLASVILLE, GA 30135-1959
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
GA
Other
Enumeration date
06/28/2024
Last updated
06/28/2024
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