Individual
KRYSTAL LYNN PENLEY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LDO
Contact information
Practice address
346 N GRADY STREET, PORTAL, GA 30450
(912) 536-9451
Mailing address
246 NORTH GRADY STREET, PORTAL, GA 30450
(912) 536-9451
Taxonomy
Speciality
Code
Description
License number
State
156FX1800X
Optician
Primary
2341
GA
Other
Enumeration date
07/15/2021
Last updated
07/15/2021
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