Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 174N00000X | Lactation Consultant | GA | |
N | 225700000X | Massage Therapist | MT011527 | GA |
NPI | 1073198875 |
---|---|
Provider Name | Courtney Coley |
First Address | Bonaire, GA 31005-3651 |
Second Address | Bonaire, GA 31005-3718 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/03/2021 |
Last Update Date | 12/03/2021 |