Provider Information for 1043621725
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ACEA STARKS
Sex: Female
NPI: 1043621725
Last Updated: 2014-05-15
Certification Date:
Certification Date:
Details
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NPI | 1043621725 | ||||||||||||||||
Enumeration Date | 2014-05-15 | ||||||||||||||||
NPI Type | NPI-1 Individual | ||||||||||||||||
Sole Proprietor | NO | ||||||||||||||||
Status | Active | ||||||||||||||||
Mailing Address | 479 COTTER ST RINGGOLD, GA 30736-2337 United States Phone: 706-937-5180 | Fax: | ||||||||||||||||
Primary Practice Address | 479 COTTER ST RINGGOLD, GA 30736-2337 United States Phone: 706-937-5180 | Fax: | ||||||||||||||||
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