Individual
JACKQUELYN COUNTEE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
805 LAUSANNE DR, VALDOSTA, GA 31601-4152
(678) 245-9472
Mailing address
805 LAUSANNE DR, VALDOSTA, GA 31601-4152
(678) 245-9472
Taxonomy
Speciality
Code
Description
License number
State
172A00000X
Driver
Primary
—
—
Other
Enumeration date
08/16/2022
Last updated
08/16/2022
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