Healthcare Provider Details

I. General information

NPI: 1629270483
Provider Name (Legal Business Name): TAMERA FIRNBACH D.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/04/2007
Last Update Date: 07/15/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5150 STILESBORO RD NW SUITE 420
KENNESAW GA
30152-7744
US

IV. Provider business mailing address

5150 STILESBORO RD NW SUITE 420
KENNESAW GA
30152-7744
US

V. Phone/Fax

Practice location:
  • Phone: 770-425-6068
  • Fax: 770-425-6085
Mailing address:
  • Phone: 770-425-6068
  • Fax: 770-425-6085

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NN1001X
TaxonomyNutrition Chiropractor
License NumberCHIR006878
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: