Individual
MACIE OWENS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
180 BURKETTS FERRY RD, HAZLEHURST, GA 31539-7132
(912) 293-4677
Mailing address
180 BURKETTS FERRY RD, HAZLEHURST, GA 31539
(912) 293-4677
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
PTA001143
GA
Other
Enumeration date
03/02/2017
Last updated
03/02/2017
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