Individual
MRS. MOLLY SMITH INGRAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
1331 APPLING HARLEM RD, HARLEM, GA 30814-4130
(706) 556-2012
Mailing address
516 MARTIN LN, AUGUSTA, GA 30909-3406
(478) 365-1215
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
12634
GA
363A00000X
Physician Assistant
Primary
12634
GA
Other
Enumeration date
08/08/2024
Last updated
12/10/2024
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