Individual
IDALID LARA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
3516 MARION CT, BUFORD, GA 30519-4059
(470) 546-2090
Mailing address
3516 MARION CT, BUFORD, GA 30519-4059
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
—
—
Other
Enumeration date
11/29/2024
Last updated
11/29/2024
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