Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN1001X | Nutrition | CHIRO08901 | GA |
NPI | 1467596742 |
---|---|
Provider Name | Dr. Silva Tavitian |
First Address | Lilburn, GA 30047-5974 |
Second Address | Tucker, GA 30084-5139 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/02/2007 |
Last Update Date | 08/07/2007 |