Individual
TEKIA RUSSELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1190 LAWANNA DR, BAXLEY, GA 31513-6859
(912) 347-5076
Mailing address
1190 LAWANNA DR, BAXLEY, GA 31513-6859
(912) 347-5076
Taxonomy
Speciality
Code
Description
License number
State
372600000X
Adult Companion
Primary
—
—
3747A0650X
Attendant Care Provider
—
—
Other
Enumeration date
11/26/2021
Last updated
11/26/2021
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