Individual
MR. GARY STEVEN KOLLER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
76 HOLDER ROAD, LUMPKIN, GA 31815
(229) 838-1241
(229) 838-1242
Mailing address
79 HOLDER ROAD, LUMPKIN, GA 31815
(229) 838-1241
Taxonomy
Speciality
Code
Description
License number
State
364SF0001X
Family Health Clinical Nurse Specialist
Primary
RN218792
GA
Other
Enumeration date
01/07/2014
Last updated
06/30/2015
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