Individual
WENDALL KEITH JEFFERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1719 12TH ST, PHENIX CITY, AL 36867-6044
(404) 307-5251
Mailing address
1719 12TH ST, PHENIX CITY, AL 36867-6044
(404) 307-5251
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
—
AL
Other
Enumeration date
02/24/2025
Last updated
03/22/2025
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