Healthcare Provider Details

I. General information

NPI: 1962997445
Provider Name (Legal Business Name): ZILLAH NGUM ANAGHO TAH NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/26/2018
Last Update Date: 03/10/2026
Certification Date: 03/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

777 HEMLOCK ST
MACON GA
31201-2102
US

IV. Provider business mailing address

106 MONTICELLO DR
BYRON GA
31008-9576
US

V. Phone/Fax

Practice location:
  • Phone: 318-243-7502
  • Fax:
Mailing address:
  • Phone: 318-243-7502
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number2025069566
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License NumberF03180516
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: