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Individual

BRODY LATHEM

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man

Contact information

Practice address
3833 N OAK STREET EXT, VALDOSTA, GA 31605-1153
(229) 985-4815
Mailing address
3833 N OAK STREET EXT, VALDOSTA, GA 31605-1153

Taxonomy

Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary

Other

Enumeration date
04/17/2022
Last updated
04/01/2025
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