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General NPI Number Information
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NPI Number | 1710251004
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Entity Type | Individual
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Provider Name | TARA EILEEN FERNALLD LAC, DAOM
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Gender | Female
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Dates
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Enumeration Date | 03/04/2012
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Last Update Date | 08/15/2023
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Provider Practice Location Address
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Address Line | 135 CELIA CT
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City | ALPHARETTA
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State | GA
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Zip | 30022-7153
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Country | US
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Telephone | 678-793-3834
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Fax |
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Provider Business Mailing Address
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Address Line | LANDSTUHL REGIONAL MEDICAL CENTER UNIT 33100
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City | APO
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State | OVERSEAS MILITARY TREATMENT FACILITY
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Zip | 09180
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Country | AE
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | 3448
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | 225
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License Number State | GA
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