Individual
TAMISHA LAQUINNA LOUDER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1214 N COLUMBIA AVE STE B, RINCON, GA 31326-6815
(912) 412-4568
Mailing address
1214N COLUMBIA AVENUE UNIT B, RINCON, GA 31326
(912) 412-4568
Taxonomy
Speciality
Code
Description
License number
State
1744P3200X
Prosthetics Case Management
Primary
CO127306
GA
Other
Enumeration date
03/21/2016
Last updated
03/21/2016
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