Individual
TANYA LASHON CORNELIUS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
504 ARLENE LN, SPARKS, GA 31647-7238
(229) 402-3833
Mailing address
504 ARLENE LN, SPARKS, GA 31647-7238
(229) 402-3833
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
—
GA
171W00000X
Contractor
—
—
Other
Enumeration date
02/13/2020
Last updated
02/13/2020
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