Individual
KENNETH DANIEL PAULK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
230 W CLOVERHURST AVE, ATHENS, GA 30605-1228
(912) 678-3186
Mailing address
230 W CLOVERHURST AVE, ATHENS, GA 30605-1228
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Enumeration date
11/14/2016
Last updated
11/14/2016
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