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Individual

MARIAH WOOD THAXTON

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
P.A.

Contact information

Practice address
821 N COBB ST, MILLEDGEVILLE, GA 31061-2343
(478) 457-7128
Mailing address
1051 STONE SHOALS CT, WATKINSVILLE, GA 30677-2774
(478) 457-7128

Taxonomy

Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
005696
GA

Other

Enumeration date
05/08/2010
Last updated
05/08/2010
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