Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN1001X | Nutrition | CHIR006878 | GA |
NPI | 1629270483 |
---|---|
Provider Name | Tamera Firnbach |
First Address | Kennesaw, GA 30152-7744 |
Second Address | Kennesaw, GA 30152-7744 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/06/2007 |
Last Update Date | 15/07/2007 |