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General NPI Number Information
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NPI Number | 1700127206
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Entity Type | Organization
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Legal Business Name | SALLY M WAY TULLY
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Dates
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Enumeration Date | 03/07/2013
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Last Update Date | 03/07/2013
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Provider Practice Location Address
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Address Line | 10164 FORD AVE STE D
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City | RICHMOND HILL
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State | GA
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Zip | 31324-3948
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Country | US
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Telephone | 912-660-1100
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1822
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City | RICHMOND HILL
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State | GA
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Zip | 31324-1822
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Country | US
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Telephone | 912-660-1100
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MRS. SALLY M WAY TULLY
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Credential | BCBA
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Telephone | 912-660-1100
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | 1-13-12747
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License Number State |
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