Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YS0123X | Facial Plastic Surgeon | 88586 | GA |
NPI | 1346637543 |
---|---|
Provider Name | Tanisha Hutchinson |
First Address | Lawrenceville, GA 30046-8765 |
Second Address | Lawrenceville, GA 30046-8765 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/04/2015 |
Last Update Date | 26/07/2021 |