Individual
JISMARIA ANTONY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1601 WATSON BLVD, WARNER ROBINS, GA 31093-3431
(478) 975-6880
Mailing address
1601 WATSON BLVD, WARNER ROBINS, GA 31093-3431
(478) 975-6880
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
16648
GA
Other
Enumeration date
07/03/2024
Last updated
07/25/2024
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