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MRS. KEISHANNA BERNAE' ANTHONY BA, PP

>> Contractor >> Other Service Providers

Registrant NPI Number: 1548736630

Individual Registrant:
MRS. KEISHANNA BERNAE' ANTHONY BA, PP
Gender: F
Not Sole Proprietor

Location and contact information for practice:
1463 JONES AVE  VALDOSTA, GA 31601-4294 US
Tel: 770-354-2382  Fax: --

Contact information for business:
1463 JONES AVE  VALDOSTA, GA 31601-4294 US
Tel: 770-354-2382  Fax: --

Registration Information:
NPI: 1548736630
Entity Type: Individual

Specialty information:

PrimaryCodeCategory/DescriptionStateLicense Number
Y171W00000XOther Service Providers
Contractor
GA056311378

Legacy codes, insurance codes and state license numbers:

IssuerNumberStateType




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