Provider Demographics
NPI:1629762109
Name:MINNITEE, JULIA-INEZ M
Entity Type:Individual
Prefix:
First Name:JULIA-INEZ
Middle Name:M
Last Name:MINNITEE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2378 BOULDER SPRINGS DR
Mailing Address - Street 2:
Mailing Address - City:ELLENWOOD
Mailing Address - State:GA
Mailing Address - Zip Code:30294-1773
Mailing Address - Country:US
Mailing Address - Phone:678-895-8902
Mailing Address - Fax:
Practice Address - Street 1:2378 BOULDER SPRINGS DR
Practice Address - Street 2:
Practice Address - City:ELLENWOOD
Practice Address - State:GA
Practice Address - Zip Code:30294-1773
Practice Address - Country:US
Practice Address - Phone:678-895-8902
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-07
Last Update Date:2023-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician