Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 224P00000X | Prosthetist | C0134100 | GA |
NPI | 1235773573 |
---|---|
Provider Name | Tanya Lashawn Arnold |
First Address | Duluth, GA 30096-5090 |
Second Address | Decatur, GA 30033-1852 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 30/10/2019 |
Last Update Date | 30/10/2019 |