Healthcare Provider Details

I. General information

NPI: 1114858586
Provider Name (Legal Business Name): KIREN TUSHAR NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/26/2026
Last Update Date: 05/26/2026
Certification Date: 05/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2035 FLAT SHOALS RD SE
CONYERS GA
30013-1809
US

IV. Provider business mailing address

985 DOGWOOD PARK DR
LAWRENCEVILLE GA
30046-9335
US

V. Phone/Fax

Practice location:
  • Phone: 770-922-1778
  • Fax:
Mailing address:
  • Phone: 678-895-3592
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN-NP293288
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: