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Individual

MRS. OCTAVIA KEISHA LUSANE-WILLIAMS

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
RN

Contact information

Practice address
625 CRABAPPLE PL, MACON, GA 31217-5575
(478) 227-2799
(478) 312-9740
Mailing address
PO BOX 156, DRY BRANCH, GA 31020-0156
(478) 227-2799
(478) 312-9740

Taxonomy

Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
RN231748
GA
247ZC0005X
Clinical Laboratory Director (Non-physician)
Primary

Other

Enumeration date
06/08/2022
Last updated
06/08/2022
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