Individual
MATILDA N NJU
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
41 KELSO WAY, DALLAS, GA 30132-2618
(678) 457-7790
Mailing address
41 KELSO WAY, DALLAS, GA 30132-2618
(678) 457-7790
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
RN224893
GA
Other
Enumeration date
09/14/2019
Last updated
11/09/2023
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