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Derrick Staten
NPI 1891540555 · on the registry since 2024 · sole proprietor
Practice
- Address
- 518 Mount Gerizim Rd Se
Mableton, GA 30126 - Phone
- (470) 654-2331
Registry record
- Primary taxonomy
- 343900000X
343900000X
- Licence states on file
- GA
From the registry's licence fields, which are often incomplete.
- Sex
- Male
- Record last updated
- 2024-04-17
Source: CMS National Plan and Provider Enumeration System. Registration is not the same as practising, and the registry records no retirement — some people listed here no longer practise. More in Georgia