Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 174N00000X | Lactation Consultant |
NPI | 1073023222 |
---|---|
Provider Name | Tashara Johnson |
First Address | Morrow, GA 30260-3313 |
Second Address | Jonesboro, GA 30236-3300 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/10/2017 |
Last Update Date | 02/10/2017 |