Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 124Q00000X | Dental Hygienist | DH010828 | GA |
NPI | 1033448451 |
---|---|
Provider Name | Mrs. Wendy M Hancock |
First Address | Tifton, GA 31793-8478 |
Second Address | Ashburn, GA 31714-1918 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/12/2009 |
Last Update Date | 14/12/2009 |