Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 126800000X | Dental Assistant |
NPI | 1285921122 |
---|---|
Provider Name | Ms. Tatiyana L Williamson |
First Address | Powder Springs, GA 30127-8212 |
Second Address | Powder Springs, GA 30127-8212 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 29/06/2011 |
Last Update Date | 29/06/2011 |