Individual
TALISA ESTEVES
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
BA
Contact information
Practice address
220 N MAIN ST, FITZGERALD, GA 31750-2520
(229) 345-4207
Mailing address
220 N MAIN ST, FITZGERALD, GA 31750-2520
(229) 345-4207
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
—
—
Other
Enumeration date
04/25/2018
Last updated
04/25/2018
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