Individual
MRS. KOTERA JOVANE HAYNES
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1641 ZACHARYS WAY, MCDONOUGH, GA 30253-9027
(470) 453-7126
Mailing address
1641 ZACHARYS WAY, MCDONOUGH, GA 30253-9027
(470) 453-7126
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
LPN091357
GA
Other
Enumeration date
10/08/2025
Last updated
10/08/2025
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