Individual
LASSINA WILL KOIDIMA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
AGACNP
Contact information
Practice address
1635 PONDSIDE DR, STATESBORO, GA 30458-3777
(912) 507-9077
Mailing address
1635 PONDSIDE DR, STATESBORO, GA 30458-3777
(912) 507-9077
Taxonomy
Speciality
Code
Description
License number
State
363LA2100X
Acute Care Nurse Practitioner
Primary
RN220878
GA
Other
Enumeration date
06/21/2019
Last updated
11/11/2021
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