Individual
KERRYN CASTELLON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DO
Contact information
Practice address
55 SUDDERTH ST, BUFORD, GA 30518-3335
(678) 458-5095
Mailing address
55 SUDDERTH ST, BUFORD, GA 30518-3335
(678) 458-5095
Taxonomy
Speciality
Code
Description
License number
State
156FX1800X
Optician
Primary
LDO002538
GA
3747A0650X
Attendant Care Provider
—
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
824147685
—
GA
Enumeration date
07/25/2018
Last updated
07/25/2018
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