Individual
SHANNON GREENE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
6132 HAWKINSVILLE RD, MACON, GA 31216-5848
(478) 788-0066
Mailing address
6132 HAWKINSVILLE RD, MACON, GA 31216-5848
(478) 788-0066
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
LPN085959
GA
Other
Enumeration date
11/13/2019
Last updated
11/13/2019
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