Individual
TILLMAN BLAKE HARDIGREE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CST
Contact information
Practice address
3855 PLEASANT HILL RD STE 470, DULUTH, GA 30096-1417
(770) 813-8888
Mailing address
602 WARREN WAY, WINDER, GA 30680
Taxonomy
Speciality
Code
Description
License number
State
246ZS0410X
Surgical Technologist
Primary
078608
GA
Other
Enumeration date
07/12/2013
Last updated
07/12/2013
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