Most Relevant Information
Provider Data
| NPI Number: | 1003463605 |
| Provider Name: | MARY PAULK |
| Entity Type: | Individual |
| Taxonomy Code: | 3747A0650X |
| Specialty: | Technician |
| License Number: |
Most Important Dates
| Enumeration Date: | 08/20/2019 |
| Last Updated: | 08/20/2019 |
Provider Practice Location
303 N ELM STREET
OCILLA
GA
31774
Practice Location Phone/Fax
| Phone: | 2294685748 |
| Fax: |
Provider Mailing Location
303 N ELM STREET
OCILLA
GA
31774
Provider Mailing Phone/Fax
| Phone: | 2294685748 |
| Fax: |