Individual
GLENN DALE MORAGNE
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
LPN
Contact information
Practice address
2808 HAVENWOOD DR, CONYERS, GA 30094-8005
(770) 761-6502
Mailing address
2808 HAVENWOOD DR, CONYERS, GA 30094-8005
(770) 294-6502
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
LPN037929
GA
Other
Enumeration date
06/18/2006
Last updated
07/08/2007
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