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1790311223
DESTINA SHANTE REID
LAGRANGE, GA
NPI
1790311223
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Former Name
DESTINA SHANTE CAMPBELL
Entity Type
Individual
Gender
Female
Sole Proprietor ?
No
Primary Taxonomy
363A00000X Physician Assistant
(Licence: GA 9661)
Enumeration Date
2020-03-16
Last Update Date
2020-03-16
Business Address
DESTINA SHANTE REID PA-C
108 EDGEWOOD AVE
LAGRANGE, GA 30241-6116
Phone number: 706-415-0370
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Mailing Address
DESTINA SHANTE REID PA-C
108 EDGEWOOD AVE
LAGRANGE, GA 30241-6116
Phone number: 706-415-0370
Copy
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