Healthcare Provider Details

I. General information

NPI: 1811876808
Provider Name (Legal Business Name): TENISHA Y BIBBS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/02/2025
Last Update Date: 09/02/2025
Certification Date: 09/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 GALLERIA PKWY SE STE 1500
ATLANTA GA
30339-5953
US

IV. Provider business mailing address

3201 WEXFORD WALK DR SE
SMYRNA GA
30080-8707
US

V. Phone/Fax

Practice location:
  • Phone: 404-357-7905
  • Fax:
Mailing address:
  • Phone: 678-522-9332
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174N00000X
TaxonomyLactation Consultant (Non-RN)
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number StateNULL
# 3
Primary TaxonomyY
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: