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General NPI Number Information
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NPI Number | 1659194694
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Entity Type | Individual
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Provider Name | LAVON PATRICE STURKEY
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Gender | Female
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Dates
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Enumeration Date | 11/07/2024
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Last Update Date | 11/07/2024
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Provider Practice Location Address
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Address Line | 420 AUTREY DR
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City | DOUGLASVILLE
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State | GA
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Zip | 30134-4826
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Country | US
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Telephone | 706-725-5858
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Fax | 706-979-6468
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Provider Business Mailing Address
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Address Line | 155 CHEROKEE PL # 1049
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City | CARTERSVILLE
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State | GA
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Zip | 30121-2966
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Country | US
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Telephone | 706-725-5858
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Fax | 706-979-6468
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State |
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