Provider Demographics
NPI:1477810018
Name:SNOW, TINA MARIE (LMT)
Entity Type:Individual
Prefix:MS
First Name:TINA
Middle Name:MARIE
Last Name:SNOW
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:TINA
Other - Middle Name:MARIE
Other - Last Name:SNOW
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:420 RIDGE AVE N
Mailing Address - Street 2:
Mailing Address - City:TIFTON
Mailing Address - State:GA
Mailing Address - Zip Code:31794-4326
Mailing Address - Country:US
Mailing Address - Phone:229-339-0540
Mailing Address - Fax:
Practice Address - Street 1:420 RIDGE AVE N
Practice Address - Street 2:
Practice Address - City:TIFTON
Practice Address - State:GA
Practice Address - Zip Code:31794-4326
Practice Address - Country:US
Practice Address - Phone:229-339-0540
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-20
Last Update Date:2012-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAMT007126174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist