Healthcare Provider Details

I. General information

NPI: 1790086601
Provider Name (Legal Business Name): TANYA HANCOCK ADAMS NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TANYA LEIGH HANCOCK NP

II. Dates (important events)

Enumeration Date: 11/09/2010
Last Update Date: 11/09/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 NOMORA DRIVE
DANIELSVILLE GA
30633
US

IV. Provider business mailing address

PO BOX 1110
DANIELSVILLE GA
30633-1110
US

V. Phone/Fax

Practice location:
  • Phone: 706-795-9588
  • Fax: 706-795-0969
Mailing address:
  • Phone: 706-795-9588
  • Fax: 706-795-0969

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN120873
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: