Individual
DR. BODANIELLE S PARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
L.AC, PHDOM
Contact information
Practice address
333 SWANSON DR STE 102, LAWRENCEVILLE, GA 30043-8537
(678) 878-3069
(678) 878-4455
Mailing address
PO BOX 490186, LAWRENCEVILLE, GA 30049-0004
(678) 878-3069
(678) 878-4455
Taxonomy
Speciality
Code
Description
License number
State
171100000X
Acupuncturist
Primary
355
GA
Other
Enumeration date
01/06/2012
Last updated
02/17/2021
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