Healthcare Provider Details

I. General information

NPI: 1932003159
Provider Name (Legal Business Name): MS. TENECIA LANAE LUSTER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

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

III. Provider practice location address

2651 FAVOR RD SW APT 1A2
MARIETTA GA
30060-5212
US

IV. Provider business mailing address

2651 FAVOR RD SW APT 1A2
MARIETTA GA
30060-5212
US

V. Phone/Fax

Practice location:
  • Phone: 470-630-9175
  • Fax:
Mailing address:
  • Phone: 470-630-9175
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License Number
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: