Individual
WASANA J PHOUANGMALAY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CST, CSFA
Contact information
Practice address
137 SOUTH AVE, JONESBORO, GA 30236-4948
(404) 435-3216
Mailing address
137 SOUTH AVE, JONESBORO, GA 30236-4948
(404) 435-3216
Taxonomy
Speciality
Code
Description
License number
State
246ZC0007X
Surgical Assistant
Primary
—
—
Other
Enumeration date
05/15/2024
Last updated
05/15/2024
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