Healthcare Provider Details

I. General information

NPI: 1770964934
Provider Name (Legal Business Name): TANYA A THOMAS NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: TANYA A THOMAS NP

II. Dates (important events)

Enumeration Date: 06/13/2015
Last Update Date: 03/06/2026
Certification Date: 03/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

78 SOUTHERN GOLF CT
FAYETTEVILLE GA
30215-8008
US

IV. Provider business mailing address

78 SOUTHERN GOLF CT
FAYETTEVILLE GA
30215-8008
US

V. Phone/Fax

Practice location:
  • Phone: 678-472-4386
  • Fax:
Mailing address:
  • Phone: 678-472-4386
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAP141168
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN177598
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: