Individual
MRS. KHAYRASSA L CANTRELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-S
Contact information
Practice address
720 WESTVIEW DR SW, ATLANTA, GA 30310-1458
(404) 756-1959
Mailing address
5162 OLIVIA TRL, STONE MOUNTAIN, GA 30088-4311
(678) 558-8980
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
12060
GA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
06/22/2022
Last updated
01/18/2024
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