Individual
DERRICK K STATEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
518 MOUNT GERIZIM RD SE, MABLETON, GA 30126-6410
(470) 654-2331
Mailing address
518 MOUNT GERIZIM RD SE, MABLETON, GA 30126-6410
(470) 654-2331
Taxonomy
Speciality
Code
Description
License number
State
343900000X
Non-emergency Medical Transport (VAN)
Primary
24064864
GA
Other
Enumeration date
04/17/2024
Last updated
04/17/2024
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