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Individual

MRS. GLENDA JOANN HOLLIS

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
LPN

Contact information

Practice address
SANDVALLEY ROAD 10596, AVERA, GA 30803
(912) 245-4504
Mailing address
P.O. BOX 85, KINGDOM KARE & KOMFORT, WRENS, GA 30833
(912) 245-4504

Taxonomy

Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
LPN050212
GA
172A00000X
Driver
055768176
GA
372600000X
Adult Companion
374U00000X
Home Health Aide

Other

Enumeration date
01/20/2015
Last updated
01/21/2015
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