Individual
SHONTAVIA CHARISSA DENNIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1644 FRESNO ST, VALDOSTA, GA 31602-7200
(229) 262-9093
Mailing address
1644 FRESNO STREET, VALDOSTA, GA 31602-7200
(229) 262-9093
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
—
—
Other
Enumeration date
03/22/2023
Last updated
03/22/2023
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