Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208000000X | Pediatrician | 29665 | TN |
NPI | 1003882309 |
---|---|
Provider Name | Yolanda Spraggins |
First Address | Hixson, TN 37343-5470 |
Second Address | Chatt, TN 37421 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/02/2006 |
Last Update Date | 05/03/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
G60424 | (02) |