Healthcare Provider Details

I. General information

NPI: 1871367862
Provider Name (Legal Business Name): TANESHA NOBLES APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/09/2023
Last Update Date: 03/05/2026
Certification Date: 03/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

445 WINN WAY FL 2
DECATUR GA
30030-1707
US

IV. Provider business mailing address

1163 W PEACHTREE ST NE APT 2112
ATLANTA GA
30309-4546
US

V. Phone/Fax

Practice location:
  • Phone: 404-294-3836
  • Fax: 678-702-8824
Mailing address:
  • Phone: 646-535-1231
  • Fax: 678-702-8825

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberGAA-NP001815
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: