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General NPI Number Information
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NPI Number | 1063375251
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Entity Type | Individual
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Provider Name | JATAVIUS DENARD PONDER
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Gender | Male
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Dates
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Enumeration Date | 12/04/2025
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Last Update Date | 12/04/2025
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Provider Practice Location Address
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Address Line | 3993 LAWRENCEVILLE HWY NW STE 110
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City | LILBURN
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State | GA
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Zip | 30047-2831
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Country | US
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Telephone | 404-407-5224
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Fax |
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Provider Business Mailing Address
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Address Line | 4256 TILLY MILL RD APT 2536
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City | DORAVILLE
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State | GA
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Zip | 30360-3260
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number |
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License Number State |
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