Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TH0100X | Health Service |
NPI | 1629570445 |
---|---|
Provider Name | De'armond Lyshawn Toney |
First Address | Chattanooga, TN 37421-2550 |
Second Address | Chattanooga, TN 37421-2550 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/03/2018 |
Last Update Date | 07/03/2018 |