Individual
CONSTANCE ELANIE JAMISON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
3420 E PONCE DE LEON AVE, SCOTTDALE, GA 30079-1202
(770) 256-7754
Mailing address
PO BOX 1583, PINE LAKE, GA 30072-1583
(770) 256-7754
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
CO093077
LA
Other
Enumeration date
12/20/2007
Last updated
12/20/2007
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