Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 175L00000X | Homeopath | MT002297 | GA |
NPI | 1518150432 |
---|---|
Provider Name | Mrs. Tanya M High |
First Address | Conyers, GA 30012 |
Second Address | Snellville, GA 30078-7023 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/08/2007 |
Last Update Date | 23/08/2007 |