John Stephen Autry
Marriage & Family Therapist in Blackshear, GA. Individual provider (NPI-1).
NPI number1619002003
StatusActive
Last updated in NPPESJul 8, 2007
Details
- NPI
- 1619002003
- Entity type
- Individual (NPI-1)
- Name
- John Stephen Autry
- Sex
- Male
- Sole proprietor
- Yes
- Enumeration date
- Feb 23, 2007
- Last updated
- Jul 8, 2007
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 106H00000X | Marriage & Family Therapist | MFT000386 | GA | Yes |
Practice location
901 College AveBlackshear, GA 31516
Phone 912-449-2714
Mailing address
901 College AvenueBlackshear, GA 31516
Phone 912-449-2714
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