Individual
TINA MIRANDA CARVER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LDO
Contact information
Practice address
316 GASKIN AVE S, DOUGLAS, GA 31533-0015
(912) 393-3937
(912) 393-3944
Mailing address
316 GASKIN AVE S, DOUGLAS, GA 31533-0015
(912) 393-3937
(912) 393-3944
Taxonomy
Speciality
Code
Description
License number
State
156FX1800X
Optician
Primary
0001756
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1286180001
PALMETTO GBA
GA
Enumeration date
12/18/2006
Last updated
07/09/2007
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