Individual
IKEYSHANA WILLIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
17213 SUGARLOAF RESERVE DR, DULUTH, GA 30097-5209
(470) 800-2040
Mailing address
17213 SUGARLOAF RESERVE DR, DULUTH, GA 30097-5209
(470) 800-2040
Taxonomy
Speciality
Code
Description
License number
State
261QH0100X
Health Service Clinic/Center
Primary
—
—
Other
Enumeration date
03/10/2021
Last updated
03/10/2021
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