| NPI | 1902499023 |
|---|---|
| Former Name | HALLIE LOGAN BAIN |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: TN 4560) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: GA 10349) |
| Enumeration Date | 2021-02-19 |
| Last Update Date | 2023-03-13 |