Individual
MRS. PHYLLIS SUSAN RAULERSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
5955 OWENS ROAD, PATTERSON, GA 31557
(912) 449-6906
(912) 449-4689
Mailing address
5955 OWENS ROAD, PATTERSON, GA 31557
(912) 449-6906
(912) 449-4689
Taxonomy
Speciality
Code
Description
License number
State
252Y00000X
Early Intervention Provider Agency
Primary
—
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
257110638A
—
GA
Enumeration date
10/30/2011
Last updated
10/30/2011
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