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Jessica Logue

NPI Registration Record

Provider / OrganizationNPIDate Certified
JESSICA LOGUE11246459812020-06-28
Entity TypeIndividual
Provider Name Jessica Logue
Practice Office Address231 W HANCOCK ST
MILLEDGEVILLE, GA US
Practice Office Telephone4784455004
Mailing Address231 W HANCOCK ST
MILLEDGEVILLE, GA 310613375 US
HPT Codes
CodeLicense NoState
163WM0102X PRIMARYRN258772 GA
OPI Codes

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