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Individual

MRS. SHELLEY DIANE MACK

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F

Contact information

Practice address
1514 BALDWIN LAKES DR, GROVETOWN, GA 30813-5887
(706) 854-0555
(706) 651-9677
Mailing address
1514 BALDWIN LAKES DR, GROVETOWN, GA 30813-5887
(706) 854-0555
(706) 651-9677

Taxonomy

Speciality
Code
Description
License number
State
372500000X
Chore Provider
Primary
376J00000X
Homemaker

Other

Enumeration date
08/29/2010
Last updated
08/29/2010
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