Individual
TANASHA KEONNA WEST
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2990 TARA DR, VALDOSTA, GA 31602-1467
(770) 545-9681
Mailing address
2990 TARA DR, VALDOSTA, GA 31602-1467
(770) 545-9681
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
—
—
Other
Enumeration date
01/12/2022
Last updated
01/12/2022
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