Individual
SI'ARA WASHINGTON FARRIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
ATC, LMT
Contact information
Practice address
564 HILLANDALE PARK DR, LITHONIA, GA 30058-8833
(843) 718-7536
Mailing address
564 HILLANDALE PARK DR, LITHONIA, GA 30058-8833
(843) 718-7536
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
1418
SC
2255A2300X
Athletic Trainer
Primary
AT003870
GA
225700000X
Massage Therapist
9454
SC
Other
Enumeration date
09/22/2020
Last updated
09/22/2020
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