Individual
MRS. VICTORIA BROOKE LIVELY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CSFA
Contact information
Practice address
1557 JANMAR RD, SNELLVILLE, GA 30078-5686
(770) 841-6911
Mailing address
5095 VICTORIA PARK DR, LOGANVILLE, GA 30052-3039
(770) 841-6911
Taxonomy
Speciality
Code
Description
License number
State
246ZC0007X
Surgical Assistant
Primary
207194
GA
Other
Enumeration date
12/27/2021
Last updated
12/27/2021
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