Individual
GIA SHORT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
5269 BUFORD HWY NE STE 222, ATLANTA, GA 30340-1259
(470) 473-5053
Mailing address
5269 BUFORD HWY NE STE 222, ATLANTA, GA 30340-1259
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
—
—
1744P3200X
Prosthetics Case Management
Primary
—
—
Other
Enumeration date
11/29/2025
Last updated
11/29/2025
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