Individual
KANEISHA MACK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CPS-WH
Contact information
Practice address
122 GORDON COMMERCIAL DR, LAGRANGE, GA 30240-5754
(706) 845-4054
Mailing address
122 GORDON COMMERCIAL DR, LAGRANGE, GA 30240-5754
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
—
—
Other
Enumeration date
03/28/2019
Last updated
03/28/2019
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