Individual
DEVA OLI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
777 HEMLOCK ST, MACON, GA 31201-2102
(504) 930-0159
Mailing address
4420 CRAIG AVE, METAIRIE, LA 70003-7601
(504) 930-0159
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
GA
Other
Enumeration date
03/24/2026
Last updated
03/24/2026
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