Individual
KENTERRIOUS BROOKS-MIMS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
408 POINCIANA AVE, ALBANY, GA 31705-4502
(229) 255-6842
Mailing address
408 POINCIANA AVE, ALBANY, GA 31705-4502
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
—
GA
Other
Enumeration date
06/18/2017
Last updated
07/21/2022
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