Provider Demographics
NPI:1659947406
Name:WITTMEYER, DEVYN B
Entity Type:Individual
Prefix:
First Name:DEVYN
Middle Name:B
Last Name:WITTMEYER
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 1:3730 GLOUCESTER DR
Mailing Address - Street 2:
Mailing Address - City:TUCKER
Mailing Address - State:GA
Mailing Address - Zip Code:30084-7203
Mailing Address - Country:US
Mailing Address - Phone:678-759-9665
Mailing Address - Fax:
Practice Address - Street 1:3730 GLOUCESTER DR
Practice Address - Street 2:
Practice Address - City:TUCKER
Practice Address - State:GA
Practice Address - Zip Code:30084-7203
Practice Address - Country:US
Practice Address - Phone:678-759-9665
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-02
Last Update Date:2021-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician