Provider Demographics
NPI:1922175207
Name:DELOZIER, OSCAR LAUDEN JR (M DIV)
Entity Type:Individual
Prefix:MR
First Name:OSCAR
Middle Name:LAUDEN
Last Name:DELOZIER
Suffix:JR
Gender:M
Credentials:M DIV
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1051 MERIWEATHER DR
Mailing Address - Street 2:
Mailing Address - City:BOGART
Mailing Address - State:GA
Mailing Address - Zip Code:30622-3036
Mailing Address - Country:US
Mailing Address - Phone:706-549-3744
Mailing Address - Fax:706-549-3744
Practice Address - Street 1:1551 JENNINGS MILL RD UNIT 2700B
Practice Address - Street 2:
Practice Address - City:BOGART
Practice Address - State:GA
Practice Address - Zip Code:30622-2576
Practice Address - Country:US
Practice Address - Phone:706-549-3744
Practice Address - Fax:706-549-3744
Is Sole Proprietor?:No
Enumeration Date:2006-11-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA390106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist