Provider Information for 1649339961
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Mr. DARIUS ENTESARY LPC
Sex: Male
NPI: 1649339961
Last Updated: 2007-07-08
Certification Date:
Certification Date:
Details
| Name | Value | ||||||||
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| NPI | 1649339961 | ||||||||
| Enumeration Date | 2006-12-06 | ||||||||
| NPI Type | NPI-1 Individual | ||||||||
| Sole Proprietor | YES | ||||||||
| Status | Active | ||||||||
| Mailing Address | 1520 HERITAGE DR CUMMING, GA 30041-7258 United States Phone: 404-886-2362 | Fax:404-305-7947 | ||||||||
| Primary Practice Address | 1902 MACY DR ROSWELL, GA 30076-6339 United States Phone: 678-457-1447 | Fax: | ||||||||
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