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Tequilla Brew-Chann
NPI 1467209437 · on the registry since 2024
Practice
- Address
- 133 Stargaze Rdg
Canton, GA 30114 - Phone
- (999) 999-9999
Registry record
- Primary taxonomy
- 1041C0700X
1041C0700X
- Also registered as
- 1041C0700X
1041C0700X
1041C0700X - Licence states on file
- TX, WA, GA, CA
From the registry's licence fields, which are often incomplete.
- Sex
- Female
- Record last updated
- 2025-10-29
Source: CMS National Plan and Provider Enumeration System. Registration is not the same as practising, and the registry records no retirement — some people listed here no longer practise. More in Georgia