NPI 1013287150

Bodanielle S Park, LACPHDOM

Practitioner Acupuncturist Lawrenceville, GA

Practice location

Address: 333 Swanson Dr STE 102, Lawrenceville, GA 30043-8537
Phone: (678) 878-3069
Fax: (678) 878-4455
Mailing address: PO Box 490186, Lawrenceville, GA 30049-0004

Registered specialties

Acupuncturist Primary

Other Service Providers Taxonomy 171100000X Licence 355 (GA)

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Registry record

NPI: 1013287150
Entity type: Individual
Sex (as registered): Female
NPI issued: 6 Jan 2012
Record last updated: 17 Feb 2021

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.