Individual
PETAL SHIELDS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
121 OMEGA CT, DALLAS, GA 30157
(404) 786-1395
Mailing address
121 OMEGA CT, DALLAS, GA 30157-7467
(404) 786-1395
Taxonomy
Speciality
Code
Description
License number
State
172V00000X
Community Health Worker
Primary
—
—
Other
Enumeration date
12/09/2015
Last updated
12/09/2015
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