Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 226300000X | Kinesiotherapist | GA |
NPI | 1760969935 |
---|---|
Provider Name | Taylor C'mon Shackelford |
First Address | Alpharetta, GA 30004-8600 |
Second Address | Alpharetta, GA 30004 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/07/2018 |
Last Update Date | 23/07/2018 |