Individual
MR. JORGE LUIS LOPEZ-MALDONADO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LPN
Contact information
Practice address
300 W HOSPITAL RD, FORT GORDON, GA 30905-5741
(706) 787-9251
Mailing address
300 W HOSPITAL RD, FORT GORDON, GA 30905-5741
(706) 787-9251
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
LPN050471
GA
Other
Enumeration date
05/01/2008
Last updated
05/01/2008
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