Individual
GEORGIA QUEEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
618 MOUNT VERNON RIDGE RD, WAYNE, WV 25570-4629
(386) 546-0041
Mailing address
618 MOUNT VERNON RIDGE RD, WAYNE, WV 25570-4629
(386) 546-0041
Taxonomy
Speciality
Code
Description
License number
State
172V00000X
Community Health Worker
Primary
—
—
Other
Enumeration date
02/18/2021
Last updated
02/18/2021
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