Individual
EBONY GARDNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
309 MACON ST, MCDONOUGH, GA 30253-3515
(404) 772-0905
Mailing address
309 MACON ST, MCDONOUGH, GA 30253-3515
(404) 772-0905
Taxonomy
Speciality
Code
Description
License number
State
261QA0600X
Adult Day Care Clinic/Center
Primary
ADC000352
GA
Other
Enumeration date
05/21/2025
Last updated
09/15/2025
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