Individual
MRS. REGINA LOUISE ELVIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LMT
Contact information
Practice address
271A S CULVER ST, LAWRENCEVILLE, GA 30045-4805
(770) 676-6383
Mailing address
647 REBECCA ST, LAWRENCEVILLE, GA 30045-7475
(770) 378-6666
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
MT004268
GA
Other
Enumeration date
04/20/2009
Last updated
08/22/2009
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