Healthcare Provider Details

I. General information

NPI: 1730694332
Provider Name (Legal Business Name): MAN FUNG KANTZER PHD., BCBA-D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MAN FUNG LAM

II. Dates (important events)

Enumeration Date: 12/05/2017
Last Update Date: 10/06/2026
Certification Date: 10/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4375 RIVER GREEN PKWY STE 150
DULUTH GA
30096-8319
US

IV. Provider business mailing address

5350 JESS BRITT CT
CUMMING GA
30040-9555
US

V. Phone/Fax

Practice location:
  • Phone: 770-882-0848
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-14-15801
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: