Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN0400X | Neurology | CHIR008556 | GA |
NPI | 1164744058 |
---|---|
Provider Name | Dr. Justin Michael Tinsley |
First Address | Kennesaw, GA 30144 |
Second Address | Kennesaw, GA 30144 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/02/2010 |
Last Update Date | 22/06/2015 |