Individual
LEQUAWN MONTRELL JAMES
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
277 MEDICAL WAY, RIVERDALE, GA 30274
(347) 735-1504
Mailing address
600 PHIPPS BLVD NE APT 1601, ATLANTA, GA 30326-3345
(803) 394-4993
Taxonomy
Speciality
Code
Description
License number
State
163WE0003X
Emergency Registered Nurse
236509
GA
163WE0003X
Emergency Registered Nurse
95137485
CA
363LA2200X
Adult Health Nurse Practitioner
Primary
236509
GA
363LA2200X
Adult Health Nurse Practitioner
95137485
CA
Other
Enumeration date
11/08/2017
Last updated
11/05/2020
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