Individual
DR. JEVAE LENIECE NELSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DDS, DMSC
Contact information
Practice address
4070 LAVISTA RD UNIT 102, TUCKER, GA 30084-5228
(770) 515-8532
Mailing address
2554 SIBLEY DR NE, ATLANTA, GA 30324-3104
(816) 304-0482
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
DN122573
GA
1223G0001X
General Practice Dentistry
DN1857897
MA
Other
Enumeration date
05/08/2018
Last updated
02/03/2022
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