Individual
TERRANCE HOWARD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
4213 ROXBURY DR, VALDOSTA, GA 31605-7008
(229) 412-6397
Mailing address
4213 ROXBURY DR, VALDOSTA, GA 31605-7008
(229) 412-6397
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
17002166
GA
Other
Enumeration date
03/08/2017
Last updated
03/08/2017
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