Individual
TATYANA YGNACIA CARLSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
IDMT
Contact information
Practice address
710 VANGUARD WAY, MOODY AFB, GA 31699-8704
(229) 257-2778
Mailing address
3280 MITCHELL BLVD, MOODY AFB, GA 31699-1500
(229) 257-2778
Taxonomy
Speciality
Code
Description
License number
State
1710I1003X
Independent Duty Medical Technicians
Primary
—
—
Other
Enumeration date
06/13/2023
Last updated
12/13/2023
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