Healthcare Provider Details

I. General information

NPI: 1477233260
Provider Name (Legal Business Name): TIA LAVARION CHAY DNP, PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/18/2023
Last Update Date: 11/29/2024
Certification Date: 11/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3225 SHALLOWFORD RD STE 1300
MARIETTA GA
30062-7033
US

IV. Provider business mailing address

3225 SHALLOWFORD RD STE 1300
MARIETTA GA
30062-7033
US

V. Phone/Fax

Practice location:
  • Phone: 678-560-7160
  • Fax:
Mailing address:
  • Phone: 678-560-7160
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberRN279305
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: