Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician | LDO001941 | GA |
NPI | 1033605217 |
---|---|
Provider Name | Sulicia Lea Jones |
First Address | Ringgold, GA 30736-8250 |
Second Address | Ft Oglethorpe, GA 30742-4046 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/07/2018 |
Last Update Date | 11/05/2019 |