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1063009470
JOHANNE DASTINE-CORIOLAN
LOGANVILLE, GA
NPI
1063009470
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Entity Type
Individual
Gender
Female
Sole Proprietor ?
Yes
Primary Taxonomy
363LG0600X Nurse Practitioner, Gerontology
(Licence: GA RN208229)
Enumeration Date
2020-12-31
Last Update Date
2020-12-31
Business Address
JOHANNE DASTINE-CORIOLAN NP
4344 GROVE LAKE ST
LOGANVILLE, GA 30052-8155
Phone number: 770-696-1350
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Mailing Address
JOHANNE DASTINE-CORIOLAN NP
4344 GROVE LAKE ST
LOGANVILLE, GA 30052-8155
Phone number: 770-696-1350
Copy
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