Individual
ANGUS NAGAMURA BENNION
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
4920 ROSWELL RD STE 1, ATLANTA, GA 30342-2684
(470) 258-4050
(470) 408-2364
Mailing address
300 INTERNATIONAL PKWY STE 200, LAKE MARY, FL 32746-5028
(866) 610-0580
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
1-22-59822
GA
106S00000X
Behavior Technician
RBT-21-166540
GA
Other
Enumeration date
05/19/2022
Last updated
06/06/2022
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