Individual
MRS. IMOGENE W CANTRELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1129 13TH ST, COLUMBUS, GA 31901-2248
(706) 660-8877
(706) 660-8877
Mailing address
PO BOX 4618, COLUMBUS, GA 31914-0618
(706) 660-8877
(706) 660-8877
Taxonomy
Speciality
Code
Description
License number
State
335E00000X
Prosthetic/Orthotic Supplier
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00650394A
—
GA
Enumeration date
12/13/2006
Last updated
07/08/2007
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