Individual
KELLY WIEDOWER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1041 PARK DR, GREENSBORO, GA 30642-3465
(706) 453-4945
Mailing address
1081 PRINCETON LN, WATKINSVILLE, GA 30677-5338
(706) 254-3250
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
213342
GA
Other
Enumeration date
10/05/2016
Last updated
10/05/2016
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