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1710548771
LASSINA WILL KOIDIMA
STATESBORO, GA
NPI
1710548771
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
Yes
Primary Taxonomy
363LA2100X Nurse Practitioner, Acute Care
(Licence: GA RN220878)
Enumeration Date
2019-06-21
Last Update Date
2021-11-11
Business Address
LASSINA WILL KOIDIMA AGACNP
1635 PONDSIDE DR
STATESBORO, GA 30458-3777
Phone number: 912-507-9077
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Mailing Address
LASSINA WILL KOIDIMA AGACNP
1635 PONDSIDE DR
STATESBORO, GA 30458-3777
Phone number: 912-507-9077
Copy
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