Individual
LADAESHA GREEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1332 SOUTHERN DR, STATESBORO, GA 30460-1360
(843) 697-8366
Mailing address
5032 DEBORAHS LN, AWENDAW, SC 29429-4902
Taxonomy
Speciality
Code
Description
License number
State
246QM0706X
Medical Technologist
—
—
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Enumeration date
11/15/2022
Last updated
11/15/2022
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