NPI 1265131247

Katonia Elis

Practitioner Driver Hampton, GA

Practice location

Address: 101 Hillpine Trl # a, Hampton, GA 30228-2531
Phone: (678) 852-5545
Mailing address: PO Box 1147, Experiment, GA 30212-1147

Registered specialties

Driver Primary

Other Service Providers Taxonomy 172A00000X Licence 054356109 (GA)

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Registry record

NPI: 1265131247
Entity type: Individual
Sex (as registered): Female
NPI issued: 28 Feb 2023
Record last updated: 28 Feb 2023

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.