Individual
KAWANA KESIA MULLINS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PP
Contact information
Practice address
1103 S DAVIS ST, ALBANY, GA 31701
(229) 894-9740
Mailing address
1103 S DAVIS ST, ALBANY, GA 31701
(229) 894-9740
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
053726831
GA
Other
Enumeration date
02/19/2018
Last updated
02/19/2018
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