Healthcare Provider Details

I. General information

NPI: 1124321666
Provider Name (Legal Business Name): NIAMH TUNNEY PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/06/2010
Last Update Date: 12/06/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3001 MERCER UNIVERSITY DR SUITE 106 DAVIS BUILDING
ATLANTA GA
30341-4115
US

IV. Provider business mailing address

2760 PRESTON RIDGE LN
DACULA GA
30019-3147
US

V. Phone/Fax

Practice location:
  • Phone: 678-547-6439
  • Fax:
Mailing address:
  • Phone: 678-547-6172
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251N0400X
TaxonomyNeurology Physical Therapist
License NumberPT005829
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: