Individual
TAKAO IWANO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1550 MAGNOLIA ST, THOMASVILLE, GA 31792-7236
(660) 864-6124
Mailing address
1550 MAGNOLIA ST, THOMASVILLE, GA 31792-7236
(660) 864-6124
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
1956
SC
Other
Enumeration date
07/14/2016
Last updated
12/28/2018
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