Individual
LAWANDA GREENE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
770 WALNUT ST, MACON, GA 31201-7307
(478) 787-4266
(478) 787-4199
Mailing address
PO BOX 4363, MACON, GA 31208-4363
(478) 787-4266
(478) 787-4199
Taxonomy
Speciality
Code
Description
License number
State
363LG0600X
Gerontology Nurse Practitioner
Primary
RN176432
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
713878795A
—
GA
Enumeration date
04/24/2015
Last updated
05/11/2017
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