Provider Demographics
NPI:1194546457
Name:WORTHY, IRIS
Entity type:Individual
Prefix:
First Name:IRIS
Middle Name:
Last Name:WORTHY
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 1:40 E ACADEMY ST STE 582
Mailing Address - Street 2:
Mailing Address - City:LUDOWICI
Mailing Address - State:GA
Mailing Address - Zip Code:31316-1424
Mailing Address - Country:US
Mailing Address - Phone:678-818-3087
Mailing Address - Fax:
Practice Address - Street 1:40 E ACADEMY ST STE 582
Practice Address - Street 2:
Practice Address - City:LUDOWICI
Practice Address - State:GA
Practice Address - Zip Code:31316-1424
Practice Address - Country:US
Practice Address - Phone:678-818-3087
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-21
Last Update Date:2024-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician