Healthcare Provider Details

I. General information

NPI: 1366153926
Provider Name (Legal Business Name): TIONNE NICOLE PETE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/05/2022
Last Update Date: 07/24/2025
Certification Date: 07/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1459 LANEY WALKER BLVD
AUGUSTA GA
30912-3031
US

IV. Provider business mailing address

5410 NORTHLAKE CIR NE
ATLANTA GA
30345-2846
US

V. Phone/Fax

Practice location:
  • Phone: 706-721-7005
  • Fax:
Mailing address:
  • Phone: 404-940-7231
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number18098
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: