| Provider / Organization | NPI | Date Certified |
|---|---|---|
| DEEMA RASLAN | 1184228041 | 2020-11-22 |
| Entity Type | Individual |
| Provider Name | Deema Raslan |
| Practice Office Address | 307 CHURCH ST LAGRANGE, GA US |
| Practice Office Telephone | 7068843263 |
| Mailing Address | 90 COURTYARD DR NEWNAN, GA 302653163 US |
| Business Telephone | 8577708424 |
| Code | License No | State |
|---|---|---|
| 122300000X PRIMARY | DN016162T | GA |