Individual
KIZZIE IDELLA ENOCH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
130 BIRCH ST, HIRAM, GA 30141-4171
(770) 367-5357
Mailing address
130 BIRCH ST, HIRAM, GA 30141-4171
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
LPN078944
GA
164X00000X
Licensed Vocational Nurse
910718
LA
Other
Enumeration date
05/02/2006
Last updated
03/15/2026
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