Individual
JOI FEW
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
6994 MISTTOP LOOP, FAIRBURN, GA 30213-3060
(404) 960-9285
Mailing address
6994 MISTTOP LOOP, FAIRBURN, GA 30213-3060
(404) 960-9285
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
058111261
GA
Other
Enumeration date
07/11/2018
Last updated
07/11/2018
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