Individual
KEISHA DIALLO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
233 ARDSLEY PL, NORCROSS, GA 30093-5207
(240) 354-1163
Mailing address
233 ARDSLEY PL, NORCROSS, GA 30093-5207
Taxonomy
Speciality
Code
Description
License number
State
225400000X
Rehabilitation Practitioner
Primary
SLP006978
GA
Other
Enumeration date
09/30/2015
Last updated
09/30/2015
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