Organization
GOLDEN BLOOM PHRAMS INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JESSICA LANE (PRESIDENT)
(770) 633-8550
Entity
Organization
Contact information
Practice address
1172 OLD SALEM RD SE, CONYERS, GA 30094-5944
(770) 633-8550
Mailing address
1172 OLD SALEM RD SE, CONYERS, GA 30094-5944
(770) 633-8550
Taxonomy
Speciality
Code
Description
License number
State
302F00000X
Exclusive Provider Organization
Primary
—
—
Other
Enumeration date
12/03/2020
Last updated
12/03/2020
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