Individual
DERRICKAH TIARAH GARDNER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1161 PINEGLEN DR, RIVERDALE, GA 30296-3223
(251) 382-3621
Mailing address
1161 PINEGLEN DR, RIVERDALE, GA 30296-3223
(251) 382-3621
Taxonomy
Speciality
Code
Description
License number
State
343900000X
Non-emergency Medical Transport (VAN)
Primary
—
—
Other
Enumeration date
04/29/2022
Last updated
08/06/2024
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