Individual
JUSTIN RAY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
2014 PINEMOUNT BLVD, STATESBORO, GA 30461-2358
(912) 764-2995
Mailing address
2014 PINEMOUNT BLVD, STATESBORO, GA 30461-2358
(912) 764-2995
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
LPN071268
GA
Other
Enumeration date
06/03/2008
Last updated
06/03/2008
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