Healthcare Provider Details

I. General information

NPI: 1326624842
Provider Name (Legal Business Name): TONYA MICHELLE SCHELL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2021
Last Update Date: 03/23/2021
Certification Date: 03/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

171 PERRY HOUSE RD
FITZGERALD GA
31750-8837
US

IV. Provider business mailing address

133 CLARE RD
FITZGERALD GA
31750-7377
US

V. Phone/Fax

Practice location:
  • Phone: 229-423-9237
  • Fax:
Mailing address:
  • Phone: 229-425-1402
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License NumberDH010065
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: