Individual
LAWANNA TREMETRICE GRAY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
3741 COLLEGE ST, COLLEGE PARK, GA 30337-3541
(404) 914-3303
Mailing address
3741 COLLEGE ST, COLLEGE PARK, GA 30337-3541
(404) 914-3303
Taxonomy
Speciality
Code
Description
License number
State
1744P3200X
Prosthetics Case Management
Primary
CO088919
GA
Other
Enumeration date
03/04/2018
Last updated
03/04/2018
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