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Individual

FANTASIA REMONVIL

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F

Contact information

Practice address
1330 GA-74, FAYETTEVILLE, GA 30215-1458
(770) 631-2502
Mailing address
175 BLOSSOM WOOD DRIVE, SENOIA, GA 30276
(404) 717-4445

Taxonomy

Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
11418
GA

Other

Enumeration date
05/07/2021
Last updated
03/04/2023
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