Individual
EARL LOCKETTE SR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
2105 COLQUITT AVE, ALBANY, GA 31707-5011
(229) 894-3134
Mailing address
2105 COLQUITT AVE, ALBANY, GA 31707-5011
(229) 894-3134
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
053324177
GA
Other
Enumeration date
09/21/2016
Last updated
09/21/2016
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