Individual
JUANITA ANN GILLIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
4431 TARRAGON LN, DECATUR, GA 30034-6339
(404) 216-8104
Mailing address
4431 TARRAGON LN, DECATUR, GA 30034-6339
(404) 216-8104
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
LPC009660
GA
Other
Enumeration date
12/28/2021
Last updated
12/28/2021
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