Individual
DESIRE CORE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
3543 SR-81, STE 201, LOGANVILLE, GA 30052
(770) 618-9978
Mailing address
2910 STORYBOOK LN, GRAYSON, GA 30017-4202
(321) 466-3618
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
0334168
CO
Other
Enumeration date
09/11/2025
Last updated
09/11/2025
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