Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 175F00000X | Naturopath |
NPI | 1043865447 |
---|---|
Provider Name | Destiny Rickel Mcfadden |
First Address | Duluth, GA 30096-0020 |
Second Address | Duluth, GA 30096-0020 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/08/2019 |
Last Update Date | 01/11/2020 |