Provider Demographics
NPI:1770107526
Name:DOUGLAS, NATASHA MONIC (SPECIALIST)
Entity type:Individual
Prefix:
First Name:NATASHA
Middle Name:MONIC
Last Name:DOUGLAS
Suffix:
Gender:F
Credentials:SPECIALIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1630 SCENIC HWY N
Mailing Address - Street 2:
Mailing Address - City:SNELLVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30078-5647
Mailing Address - Country:US
Mailing Address - Phone:661-607-4492
Mailing Address - Fax:
Practice Address - Street 1:1630 SCENIC HWY N
Practice Address - Street 2:
Practice Address - City:SNELLVILLE
Practice Address - State:GA
Practice Address - Zip Code:30078-5647
Practice Address - Country:US
Practice Address - Phone:661-607-4492
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-07
Last Update Date:2020-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1744P3200XOther Service ProvidersSpecialistProsthetics Case ManagementGroup - Single Specialty