Individual
TARNESHIA S MADDOX
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1482 UNDERWOOD RD, SPARTA, GA 31087-9612
(478) 234-9283
Mailing address
1482 UNDERWOOD RD, SPARTA, GA 31087-9612
(478) 234-9283
Taxonomy
Speciality
Code
Description
License number
State
101YP1600X
Pastoral Counselor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
05
—
GA
Enumeration date
05/08/2019
Last updated
06/11/2019
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