Healthcare Provider Details

I. General information

NPI: 1194405167
Provider Name (Legal Business Name): TONIANN DEOLIVIERA CPM, RPT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: TONIANN DEOLIVEIRA-PAULEMON CPM

II. Dates (important events)

Enumeration Date: 07/24/2023
Last Update Date: 09/19/2026
Certification Date: 09/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4816 WILKIE WAY NW
ACWORTH GA
30102-7927
US

IV. Provider business mailing address

4816 WILKIE WAY NW
ACWORTH GA
30102-7927
US

V. Phone/Fax

Practice location:
  • Phone: 631-902-6370
  • Fax:
Mailing address:
  • Phone: 631-902-6370
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code247200000X
TaxonomyOther Technician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: