Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | CHIR010496 | GA |
N | 111NI0013X | Independent Medical Examiner | CHIR010496 | GA |
N | 111NP0017X | Pediatric Chiropractor | CHIR010496 | GA |
N | 111NR0200X | Radiology | CHIR010496 | GA |
N | 213ER0200X | Radiology | CHIR010496 | GA |
N | 111NR0400X | Rehabilitation Chiropractor | CHIR010496 | GA |
N | 111NS0005X | Chiropractic Sports Physician | CHIR010496 | GA |
N | 111NX0800X | Chiropractor Orthopedic Specialist | CHIR010496 | GA |
NPI | 1023786571 |
---|---|
Provider Name | Dr. Tiana Branch |
First Address | Marietta, GA 30064-5925 |
Second Address | Marietta, GA 30064-5925 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/08/2021 |
Last Update Date | 31/08/2021 |