Healthcare Provider Details

I. General information

NPI: 1093509028
Provider Name (Legal Business Name): TIANNA COSIMA CROOKS NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/07/2025
Last Update Date: 04/07/2025
Certification Date: 04/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

135 BRADFORD SQ STE B
FAYETTEVILLE GA
30215-1902
US

IV. Provider business mailing address

115 LAKEMONT CIR
FAYETTEVILLE GA
30215-2362
US

V. Phone/Fax

Practice location:
  • Phone: 470-646-3738
  • Fax:
Mailing address:
  • Phone: 404-660-8527
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberRN264565
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: