Individual
JONATHAN MOCK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
190 MADISON AVE NE, LUDOWICI, GA 31316-5610
(912) 271-4633
Mailing address
190 MADISON AVE NE, LUDOWICI, GA 31316-5610
Taxonomy
Speciality
Code
Description
License number
State
3747A0650X
Attendant Care Provider
Primary
—
GA
Other
Enumeration date
10/08/2019
Last updated
10/08/2019
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