Individual
DR. WILLIAM CARL BACON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.MIN.
Contact information
Practice address
50 HURT PLZ SE, SUITE 800, ATLANTA, GA 30303-2946
(404) 507-1063
Mailing address
189 CASTLEWOOD RD, TYRONE, GA 30290-2224
(404) 886-2603
Taxonomy
Speciality
Code
Description
License number
State
106H00000X
Marriage & Family Therapist
Primary
MFT000771
GA
Other
Enumeration date
01/09/2007
Last updated
07/08/2007
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