Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 103K00000X | Behavior Analyst | ||
Y | 103K00000X | Behavior Analyst | 2021-064 | AL |
N | 106E00000X | Assistant Behavior Analyst |
NPI | 1003373127 |
---|---|
Provider Name | Khaled Khamis |
First Address | Columbus, GA 31901-2248 |
Second Address | Columbus, GA 31901-2248 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/02/2019 |
Last Update Date | 28/07/2021 |