Basic Information
| Provider Information | |||||||||
| NPI: | 1518150432 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HIGH | ||||||||
| FirstName: | TANYA | ||||||||
| MiddleName: | M | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | LMT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1602 VILLAGE PLACE CIR NE | ||||||||
| Address2: | |||||||||
| City: | CONYERS | ||||||||
| State: | GA | ||||||||
| PostalCode: | 30012 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4043242132 | ||||||||
| FaxNumber: | 7706799083 | ||||||||
| Practice Location | |||||||||
| Address1: | 2121 FOUNTAIN DR | ||||||||
| Address2: | SUITE E | ||||||||
| City: | SNELLVILLE | ||||||||
| State: | GA | ||||||||
| PostalCode: | 300787023 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4046595909 | ||||||||
| FaxNumber: | 6785120115 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/23/2007 | ||||||||
| LastUpdateDate: | 08/23/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 175L00000X | MT002297 | GA | Y | Other Service Providers | Homeopath |
No ID Information.