Individual
MRS. KANDI LAUREN WILLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
58 BIG A RD, TOCCOA, GA 30577-6017
(706) 827-2607
Mailing address
PO BOX 746216, ATLANTA, GA 30374-6216
(770) 219-8420
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
7204
GA
Other
Enumeration date
04/15/2014
Last updated
01/19/2023
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