Provider Demographics
NPI:1235773573
Name:ARNOLD, TANYA LASHAWN (HAIR LOSS SPECIALIST)
Entity Type:Individual
Prefix:
First Name:TANYA
Middle Name:LASHAWN
Last Name:ARNOLD
Suffix:
Gender:F
Credentials:HAIR LOSS SPECIALIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4155 SATELLITE BLVD
Mailing Address - Street 2:#1214
Mailing Address - City:DULUTH
Mailing Address - State:GA
Mailing Address - Zip Code:30096-5090
Mailing Address - Country:US
Mailing Address - Phone:813-808-3762
Mailing Address - Fax:
Practice Address - Street 1:1431 MCLENDON DR STE B
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30033-1852
Practice Address - Country:US
Practice Address - Phone:813-808-3762
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-30
Last Update Date:2019-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAC0134100224P00000X, 1744P3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1744P3200XOther Service ProvidersSpecialistProsthetics Case Management
No224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetist