Individual
GABRIELLE ANNASTASIA HARTAGE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
120 N DUDLEY ST, AMERICUS, GA 31709-3410
(229) 815-5454
Mailing address
138 CHARLESTON DR, AMERICUS, GA 31709-5427
(229) 938-9584
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
LPN095787
GA
Other
Enumeration date
04/04/2018
Last updated
04/04/2018
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