Healthcare Provider Details

I. General information

NPI: 1750774600
Provider Name (Legal Business Name): TAHEERAH MURRAY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/16/2015
Last Update Date: 03/16/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1061 HARMON AVE SUITE 1D03 BLDG 308
FORT STEWART GA
31314-5641
US

IV. Provider business mailing address

1061 HARMON AVE SUITE 1D03 BLDG 308
FORT STEWART GA
31314-5641
US

V. Phone/Fax

Practice location:
  • Phone: 912-435-5148
  • Fax:
Mailing address:
  • Phone: 912-435-5148
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247200000X
TaxonomyOther Technician
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: