Individual
MRS. KRISTIE ANN MCCANN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
136 S HOUSTON LAKE RD, WARNER ROBINS, GA 31088-6300
(478) 953-1020
Mailing address
136 S HOUSTON LAKE RD, WARNER ROBINS, GA 31088-6300
(478) 953-1020
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
9868
GA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
04/29/2019
Last updated
09/04/2020
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