Provider Demographics
NPI:1700532884
Name:MINOR, PORSHE TIARA (DC)
Entity Type:Individual
Prefix:DR
First Name:PORSHE
Middle Name:TIARA
Last Name:MINOR
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2020 POWERS FERRY RD SE UNIT 1566
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30339-5158
Mailing Address - Country:US
Mailing Address - Phone:901-603-2623
Mailing Address - Fax:
Practice Address - Street 1:1050 SHILOH RD NW STE 303
Practice Address - Street 2:
Practice Address - City:KENNESAW
Practice Address - State:GA
Practice Address - Zip Code:30144-7197
Practice Address - Country:US
Practice Address - Phone:770-370-7588
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-27
Last Update Date:2022-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIRO010689111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor