NPI 1619002003 · live from the CMS NPI Registry
John Stephen Autry
Marriage & Family Therapist in Blackshear, GA. National Provider Identifier 1619002003, active.
NPI record
| NPI | 1619002003 Type 1 · individual |
|---|---|
| Status | Active |
| Primary specialty | Marriage & Family Therapist 106H00000X |
| Practice location | 901 College Ave, Blackshear, GA 31516 |
| Practice phone | 912-449-2714 |
| Mailing address | 901 College Avenue, Blackshear, GA 31516 |
| Enumerated | February 23, 2007 |
| Last updated | July 8, 2007 |
| Sole proprietor | Yes |
Taxonomies and licenses
| Taxonomy | Code | License |
|---|---|---|
| Marriage & Family Therapist primary | 106H00000X | MFT000386 (GA) |
Source: CMS NPPES NPI Registry. NPI data is self-reported by providers; license numbers are not verified by CMS.