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Individual

LADAWN JERVANICKIO HALL

Active
Sole proprietor
No

Provider details

NPI number
Gender
F

Contact information

Practice address
2131 PACE ST, COVINGTON, GA 30014-6652
(678) 999-6416
Mailing address
2131 PACE ST, COVINGTON, GA 30014-6652
(678) 999-6416

Taxonomy

Speciality
Code
Description
License number
State
246RP1900X
Phlebotomy Technician
Primary
373H00000X
Day Training/Habilitation Specialist
374700000X
Technician

Other

Enumeration date
09/23/2009
Last updated
09/23/2009
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