Individual
DANA GELANE TIDWELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
218 STONEWALL ST, CARTERSVILLE, GA 30120-3628
(770) 386-1907
Mailing address
218 STONEWALL ST, CARTERSVILLE, GA 30120-3628
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
LPN088738
GA
Other
Enumeration date
11/05/2018
Last updated
11/05/2018
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