Provider Demographics
NPI:1235960766
Name:JAWARA, BUBA
Entity type:Individual
Prefix:
First Name:BUBA
Middle Name:
Last Name:JAWARA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3521 MOUNT VIEW RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:ANTIOCH
Mailing Address - State:TN
Mailing Address - Zip Code:37013-1458
Mailing Address - Country:US
Mailing Address - Phone:615-397-1081
Mailing Address - Fax:
Practice Address - Street 1:3521 MOUNT VIEW RIDGE DR
Practice Address - Street 2:
Practice Address - City:ANTIOCH
Practice Address - State:TN
Practice Address - Zip Code:37013-1458
Practice Address - Country:US
Practice Address - Phone:615-397-1081
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-07
Last Update Date:2024-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNBACB1158236106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician