Provider Demographics
NPI:1972120236
Name:WEBB, TINA
Entity Type:Individual
Prefix:
First Name:TINA
Middle Name:
Last Name:WEBB
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9756 YELLOW PINE RD
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:GA
Mailing Address - Zip Code:31820-4153
Mailing Address - Country:US
Mailing Address - Phone:706-763-7969
Mailing Address - Fax:
Practice Address - Street 1:9756 YELLOW PINE RD
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:GA
Practice Address - Zip Code:31820-4153
Practice Address - Country:US
Practice Address - Phone:706-763-7969
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-02
Last Update Date:2020-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor