Individual
JALISA BRIANNA THOMAS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
872 FLETCHER STANLEY RD, MONTROSE, GA 31065-3310
(478) 290-7248
Mailing address
872 FLETCHER STANLEY RD, MONTROSE, GA 31065-3310
(478) 290-7248
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
LPN094885
GA
Other
Enumeration date
01/24/2018
Last updated
01/24/2018
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