John Stephen Autry
Individual provider Active NPI Marriage & Family Therapist · Blackshear, GA
NPI 1619002003 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1619002003
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Marriage & Family Therapist 106H00000X
- License
- MFT000386 (GA)
- Practice address
- 901 College Ave
Blackshear, GA 31516 - Phone
- (912) 449-2714
- NPI assigned
- Feb 23, 2007
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MFT000386 | GA | MD | Marriage & Family Therapist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Marriage & Family Therapist | 106H00000X | MFT000386 | GA | Yes |
Addresses
Primary practice location
901 College Ave
Blackshear, GA 31516
Mailing address
901 College Avenue
Blackshear, GA 31516
Phone (912) 449-2714
Other providers in Blackshear, GA
- Angela D Adams
- Arch Theory Counseling, LLC
- Gagandeep Kaur Atwal
- B Well Family Practice
- Fredrick Winston Barber Jr.
- Barber'S Vital Care
- Alyssa Barth
- Kelli Beard
All providers in Blackshear, GA · Marriage & Family Therapist in Georgia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.