Individual
MRS. KEISHANNA BERNAE' ANTHONY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
BA, PP
Contact information
Practice address
1463 JONES AVE, VALDOSTA, GA 31601-4294
(770) 354-2382
Mailing address
1463 JONES AVE, VALDOSTA, GA 31601-4294
(770) 354-2382
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
056311378
GA
Other
Enumeration date
10/16/2018
Last updated
10/16/2018
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