Individual
MS. TAMI LYNN BACKSTROM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
L.M.T
Contact information
Practice address
7193 DOUGLAS BLVD STE 103A, DOUGLASVILLE, GA 30135-1540
(770) 845-4407
Mailing address
7193 DOUGLAS BLVD STE 103A, DOUGLASVILLE, GA 30135-1540
(770) 845-4407
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
MT005428
GA
Other
Enumeration date
12/15/2009
Last updated
12/15/2009
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