Individual
TAWANNA EASLEY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
COSMETOLOGIST
Contact information
Practice address
2900 LAJEAN DR, COLLEGE PARK, GA 30349-4148
(678) 437-6348
Mailing address
2900 LAJEAN DR, COLLEGE PARK, GA 30349-4148
(678) 437-6348
Taxonomy
Speciality
Code
Description
License number
State
1744P3200X
Prosthetics Case Management
CO093582
GA
335E00000X
Prosthetic/Orthotic Supplier
Primary
CO093582
GA
Other
Enumeration date
09/27/2023
Last updated
09/27/2023
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