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NPI 1104417039 · on the registry since 2021
Practice
- Address
- 1304 Old Countryside Cir W
Stone Mountain, GA 30083 - Phone
- (404) 578-5096
Registry record
- Primary taxonomy
- Clinical Social Worker
1041C0700X
- Sex
- Male
- Record last updated
- 2021-02-02
Source: CMS National Plan and Provider Enumeration System. Registration is not the same as practising, and the registry records no retirement — some people listed here no longer practise. More in Georgia