Individual
SHELLEY FONDREN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
5817 JAMERSON DR, ATLANTA, GA 30349-7018
(404) 822-6295
Mailing address
5817 JAMERSON DR, ATLANTA, GA 30349-7018
(404) 822-6295
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
MT000751
GA
Other
Enumeration date
07/25/2016
Last updated
07/25/2016
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