Individual
TANYA WELLMAKER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CERTIFIEDHAIRLOSSSPE
Contact information
Practice address
11180 STATE BRIDGE RD STE 402, ALPHARETTA, GA 30022-7484
(404) 334-5456
Mailing address
620 WILLOW HEIGHTS DR, ATLANTA, GA 30328-3441
(678) 830-4315
Taxonomy
Speciality
Code
Description
License number
State
1744P3200X
Prosthetics Case Management
Primary
CO119948
GA
Other
Enumeration date
05/03/2018
Last updated
05/03/2018
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