Individual
MRS. MALORY MANDERS NORTHRUP
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
1826 VETERANS BLVD, DUBLIN, GA 31021-3620
(478) 272-1210
Mailing address
285 CREEKSIDE DR, VIENNA, GA 31092-5921
(229) 322-8752
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
LPN097369
GA
Other
Enumeration date
08/17/2021
Last updated
08/17/2021
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