Individual
JOHANNE DASTINE-CORIOLAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
4344 GROVE LAKE ST, LOGANVILLE, GA 30052-8155
(770) 696-1350
Mailing address
4344 GROVE LAKE ST, LOGANVILLE, GA 30052-8155
(770) 696-1350
Taxonomy
Speciality
Code
Description
License number
State
363LG0600X
Gerontology Nurse Practitioner
Primary
RN208229
GA
Other
Enumeration date
12/31/2020
Last updated
12/31/2020
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