Healthcare Provider Details

I. General information

NPI: 1659125169
Provider Name (Legal Business Name): FIGHT LIKE A GIRL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/12/2024
Last Update Date: 04/12/2024
Certification Date: 04/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

337 FLOATING LEAF WAY
DALLAS GA
30132-7596
US

IV. Provider business mailing address

337 FLOATING LEAF WAY
DALLAS GA
30132-7596
US

V. Phone/Fax

Practice location:
  • Phone: 423-313-2597
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number
License Number State

VIII. Authorized Official

Name: LASUNDRA CASLIN
Title or Position: CFA
Credential:
Phone: 423-313-2597