Individual
MRS. ECCLESIA LUCIANA GRANT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LDO
Contact information
Practice address
5534 OLD NATIONAL HWY, SUITES 100-B, COLLEGE PARK, GA 30349-3212
(404) 432-1772
(404) 890-5574
Mailing address
165 HIDDEN BROOK CT, ATLANTA, GA 30349-4440
(404) 432-1772
(404) 890-5574
Taxonomy
Speciality
Code
Description
License number
State
156FX1800X
Optician
Primary
LDO 002273
GA
Other
Enumeration date
04/25/2010
Last updated
05/13/2010
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