Individual
PETINA LOVELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2874 KING ST SE STE B2193, SMYRNA, GA 30080-3593
(678) 856-9731
Mailing address
2874 KING ST SE STE B2193, SMYRNA, GA 30080-3593
(678) 856-9731
Taxonomy
Speciality
Code
Description
License number
State
172A00000X
Driver
—
GA
172A00000X
Driver
Primary
—
—
Other
Enumeration date
03/27/2024
Last updated
04/02/2024
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