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General NPI Number Information
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NPI Number | 1104311943
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Entity Type | Organization
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Legal Business Name | I AM TIARA MITCHELL
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Dates
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Enumeration Date | 06/25/2018
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Last Update Date | 06/25/2018
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Provider Practice Location Address
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Address Line | 3913 BRAINERD RD
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City | CHATTANOOGA
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State | TN
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Zip | 37411-3733
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Country | US
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Telephone | 423-619-3286
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Fax |
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Provider Business Mailing Address
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Address Line | 3913 BRAINERD RD
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City | CHATTANOOGA
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State | TN
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Zip | 37411-3733
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | HAIR LOSS SPECIALIST
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Name | TIARA MITCHELL
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Credential |
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Telephone | 423-619-3286
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 150039
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License Number State | TN
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