Provider Information for 1104323187
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TAYONA LANIA FRAYLON
Sex: Female
NPI: 1104323187
Last Updated: 2018-04-06
Certification Date:
Certification Date:
Details
| Name | Value | ||||||||
|---|---|---|---|---|---|---|---|---|---|
| NPI | 1104323187 | ||||||||
| Enumeration Date | 2018-04-06 | ||||||||
| NPI Type | NPI-1 Individual | ||||||||
| Sole Proprietor | YES | ||||||||
| Status | Active | ||||||||
| Mailing Address | 1143 TANK TOWN RD MATTHEWS, NC 28105-2757 United States Phone: 704-506-2566 | Fax:704-814-0323 | ||||||||
| Primary Practice Address | 134 W MATTHEWS ST MATTHEWS, NC 28105-1305 United States Phone: 704-708-4605 | Fax:704-469-5807 | ||||||||
| Secondary Practice Address(es) | 1320 MATTHEWS MINT HILL RD | ||||||||
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