Individual
AUTUMN TIERRA DAVIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LDO
Contact information
Practice address
450 NORMAN DR, VALDOSTA, GA 31601-7708
(229) 244-9118
Mailing address
450 NORMAN DR, VALDOSTA, GA 31601-7708
(229) 244-9118
Taxonomy
Speciality
Code
Description
License number
State
156FX1800X
Optician
Primary
LDO002925
GA
Other
Enumeration date
05/25/2024
Last updated
05/25/2024
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