Healthcare Provider Details

I. General information

NPI: 1922600279
Provider Name (Legal Business Name): EVELYN LEMA TANKOH MRN, APRN, AGNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/11/2020
Last Update Date: 09/19/2025
Certification Date: 09/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7130 MOUNT ZION BLVD STE 14B
JONESBORO GA
30236-2566
US

IV. Provider business mailing address

1975 HIGHWAY 54 W STE 205
PEACHTREE CITY GA
30269-4794
US

V. Phone/Fax

Practice location:
  • Phone: 770-585-2384
  • Fax: 470-288-0223
Mailing address:
  • Phone: 770-585-2384
  • Fax: 470-288-0223

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License NumberRN118032
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code163WG0600X
TaxonomyGerontology Registered Nurse
License NumberRN118032
License Number StateGA
# 3
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberRN118032
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: