Individual
MRS. SUSAN DENISE TACKETT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CPED
Contact information
Practice address
696 BREEDLOVE DR, SUITE B5, MONROE, GA 30655-2052
(404) 713-7011
(770) 207-7196
Mailing address
3551 APALACHEE RDG, MONROE, GA 30656-8535
(404) 713-7011
(770) 207-7196
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
—
—
Other
Enumeration date
10/01/2006
Last updated
07/08/2007
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