Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 106S00000X | Behavior Technician | RBT-19-81514 | GA |
NPI | 1003379512 |
---|---|
Provider Name | Aubrey Moore |
First Address | Nashville, TN 37217-2679 |
Second Address | Macon, GA 31210-1098 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/04/2019 |
Last Update Date | 11/04/2019 |