Individual
KHADESHA QUAMMIE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
504 EVERETT ST, ST SIMONS IS, GA 31522-4605
(866) 839-6979
Mailing address
504 EVERETT ST, ST SIMONS IS, GA 31522-4605
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT015644
GA
Other
Enumeration date
10/06/2022
Last updated
10/28/2022
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