Individual
OCTAVIA BOSTIC
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
7670 CREEKSIDE LANE, RIVERDALE, GA 30296
(863) 777-3846
Mailing address
7670 CREEKSIDE LN, RIVERDALE, GA 30296-1173
(863) 777-3846
Taxonomy
Speciality
Code
Description
License number
State
376K00000X
Nurse's Aide
Primary
—
GA
Other
Enumeration date
10/10/2019
Last updated
10/10/2019
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