Individual
JOANNE JERVIS-VIVILLE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
1072 PRESERVE PARK DR, LOGANVILLE, GA 30052-8405
(770) 990-4333
(770) 982-9978
Mailing address
1072 PRESERVE PARK DR, LOGANVILLE, GA 30052-8405
(770) 990-4333
(770) 982-9978
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
LPN069972
GA
Other
Enumeration date
02/17/2015
Last updated
02/17/2015
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