Individual
LYDIA C BOGGS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1020 MARY ST, WAYCROSS, GA 31503-3849
(912) 550-3382
(912) 287-6689
Mailing address
1020 MARY STREET P.O. BOX 2361, WAYCROSS, GA 31502
(912) 550-3382
(912) 287-6689
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
PENDING
—
GA
Enumeration date
04/17/2018
Last updated
04/17/2018
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