Organization
JEANPHIS LAGUERRE MD PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JUDY B RICKS (PROVIDER ENROLLMENT COORDINATOR)
(229) 891-9131
Entity
Organization
Contact information
Practice address
3007B 2ND ST SE, MOULTRIE, GA 31768-6798
(229) 891-9009
(229) 891-9141
Mailing address
PO BOX 1838, MOULTRIE, GA 31776-1838
(229) 891-9009
(229) 891-9141
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
059815
GA
Other
Enumeration date
08/29/2008
Last updated
08/29/2008
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