Healthcare Provider Details

I. General information

NPI: 1164503108
Provider Name (Legal Business Name): TAMIKO LIN D'ELENA PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TAMIKO L KOLKJEN PA-C

II. Dates (important events)

Enumeration Date: 10/18/2006
Last Update Date: 12/03/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6300 HOSPITAL PKWY STE 450
JOHNS CREEK GA
30097
US

IV. Provider business mailing address

6300 HOSPITAL PKWY SUITE 450
JOHNS CREEK GA
30097
US

V. Phone/Fax

Practice location:
  • Phone: 770-227-2222
  • Fax: 770-227-2220
Mailing address:
  • Phone: 770-227-2222
  • Fax: 770-227-2220

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number004550
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number1601000462
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: