Organization
JUDY B BAIN
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ROXIE MOTON (CREDENTIALING SPECIALIST)
(706) 594-6073
Entity
Organization
Contact information
Practice address
104 HARWELL AVE STE 236, LAGRANGE, GA 30240-3132
(706) 885-0111
(706) 885-0607
Mailing address
104 HARWELL AVE STE 236, LAGRANGE, GA 30240-3132
(706) 885-0111
(706) 885-0607
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
—
—
Other
Enumeration date
06/11/2019
Last updated
06/11/2019
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