Individual
GAILTRICIA BRENLYN FOGG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
105 TRUDIE LN, MACON, GA 31216-6168
(478) 494-0333
Mailing address
105 TRUDIE LN, MACON, GA 31216-6168
(478) 494-0333
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
LPC010555
GA
Other
Enumeration date
07/25/2023
Last updated
07/25/2023
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