Individual
EDNA SHARIE MOCK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CERT HAIR LOSS SPECI
Contact information
Practice address
2956 VINE GROVE ST, POWDER SPRINGS, GA 30127-1782
(770) 990-3944
(770) 439-8870
Mailing address
2956 VINE GROVE ST, POWDER SPRINGS, GA 30127-1782
(770) 990-3944
(770) 439-8870
Taxonomy
Speciality
Code
Description
License number
State
1744P3200X
Prosthetics Case Management
Primary
CO116503
GA
Other
Enumeration date
11/24/2013
Last updated
11/24/2013
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