Individual
TABITHA EAVES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
3131 N OAK STREET EXT APT 12F, VALDOSTA, GA 31602-1075
(912) 590-5412
Mailing address
3131 N OAK STREET EXT APT 12F, VALDOSTA, GA 31602-1075
(912) 590-5412
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
—
—
Other
Enumeration date
04/13/2017
Last updated
04/13/2017
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