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NPI Code Detail

MEDICARE: MARY OUTLAW

MEDICARE: MARY OUTLAW
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103K00000XBehavior Analyst1-26-88211SC

General Provider Information

NPI Number : 1588396030
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARY OUTLAW
Provider Business Mailing Address
First Line : 209 7TH ST FL 3
Second Line :
City : AUGUSTA
State : GA
Zip : 30901-1486
Country : US
Telephone Number : 706-842-5330
Fax Number : 706-842-5340
Provider Business Practice Location Address
First Line : 9361 TWO NOTCH RD
Second Line :
City : COLUMBIA
State : SC
Zip : 29223-6430
Country : US
Telephone Number : 706-842-5330
Fax Number : 706-842-5340
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/24/2022
Last Update Date : 03/10/2026

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Directions to “ MARY OUTLAW ” Practice Location

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