Healthcare Provider Details

I. General information

NPI: 1316613250
Provider Name (Legal Business Name): PUZZLING PATTERNS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/20/2021
Last Update Date: 03/07/2023
Certification Date: 03/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

72 DRAYTON CT
MIDWAY GA
31320-7142
US

IV. Provider business mailing address

72 DRAYTON CT
MIDWAY GA
31320-7142
US

V. Phone/Fax

Practice location:
  • Phone: 404-697-3608
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name: CHARITY I CROWELL
Title or Position: OWNER
Credential:
Phone: 904-629-8070