Individual
TATJANA MISUNINA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
2525 COURT DR STE 200, GASTONIA, NC 28054-2140
(410) 245-5367
Mailing address
PO BOX 744786, ATLANTA, GA 30374-4786
(410) 245-5367
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
0010-06802
NC
363AS0400X
Surgical Physician Assistant
C05529
MD
Other
Enumeration date
11/10/2014
Last updated
04/03/2023
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