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Individual

ALFRED ANTONIO WARE

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
NEMT

Contact information

Practice address
107 REVERE CT, LAGRANGE, GA 30241-1725
(706) 416-2888
Mailing address
107 REVERE CT, LAGRANGE, GA 30241-1725
(706) 416-2888

Taxonomy

Speciality
Code
Description
License number
State
172A00000X
Driver
Primary
055043348
GA

Other

Enumeration date
12/29/2021
Last updated
12/29/2021
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