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SERA GABRIELLE STORY

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
PA-C

Contact information

Practice address
401 W MAIN ST, SWAINSBORO, GA 30401
(478) 237-9928
Mailing address
401 W MAIN ST, SWAINSBORO, GA 30401-3110
(478) 237-9928

Taxonomy

Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
008762
GA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
003205741
GA
01
008762
GA PA LICENSE
GA
Enumeration date
04/27/2018
Last updated
12/19/2023
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