Provider Information for 1912242785
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TASHA J TEMPLE
Sex: Female
NPI: 1912242785
Last Updated: 2017-04-18
Certification Date:
Certification Date:
Details
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| NPI | 1912242785 | ||||||||||||||||||||||||
| Enumeration Date | 2012-12-05 | ||||||||||||||||||||||||
| NPI Type | NPI-1 Individual | ||||||||||||||||||||||||
| Sole Proprietor | YES | ||||||||||||||||||||||||
| Status | Active | ||||||||||||||||||||||||
| Mailing Address | 1920 DEMBRIGH LN CHARLOTTE, NC 28262-2508 United States Phone: | Fax: | ||||||||||||||||||||||||
| Primary Practice Address | 1000 MEDICAL CENTER BLVD LAWRENCEVILLE, GA 30046-7694 United States Phone: 678-312-6040 | Fax: | ||||||||||||||||||||||||
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