Individual
KATONIA ELIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
101 HILLPINE TRL # A, HAMPTON, GA 30228-2531
(678) 852-5545
Mailing address
PO BOX 1147, EXPERIMENT, GA 30212-1147
(470) 808-0131
Taxonomy
Speciality
Code
Description
License number
State
172A00000X
Driver
Primary
054356109
GA
Other
Enumeration date
02/28/2023
Last updated
02/28/2023
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