Individual
SHANE GAY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
2100 COMER AVE, COLUMBUS, GA 31904-8725
(706) 596-5500
Mailing address
107 LINCOLN LN, LAGRANGE, GA 30240-8709
(762) 323-2901
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
LPN072762
GA
Other
Enumeration date
05/20/2019
Last updated
05/20/2019
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