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NPI Code Detail

MEDICARE: CASSIE PUNCHARD

MEDICARE: CASSIE PUNCHARD
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 Analyst

General Provider Information

NPI Number : 1811537913
Entity Type Code : Individual
Provider Name (Legal Business Name) : CASSIE PUNCHARD
Provider Business Mailing Address
First Line : 2225 BEMISS RD STE D
Second Line :
City : VALDOSTA
State : GA
Zip : 31602-4819
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 3121 N OAK STREET EXT
Second Line :
City : VALDOSTA
State : GA
Zip : 31602-1099
Country : US
Telephone Number : 800-832-9419
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/07/2020
Last Update Date : 01/22/2021

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1972124410 — KELSEY FREEZE
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Directions to “ CASSIE PUNCHARD ” Practice Location

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