Individual
JALICIA BUCKHOLTS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
511 CLOVER ST, VIENNA, GA 31092-0904
(229) 815-1325
Mailing address
511 CLOVER ST, VIENNA, GA 31092-0904
(229) 815-1325
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
310515
GA
Other
Enumeration date
06/29/2022
Last updated
06/29/2022
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