Healthcare Provider Details

I. General information

NPI: 1699603886
Provider Name (Legal Business Name): ANITA TANKO RRT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/11/2026
Last Update Date: 05/11/2026
Certification Date: 05/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

952 MAPLE LEAF DR
MCDONOUGH GA
30253-8083
US

IV. Provider business mailing address

952 MAPLE LEAF DR
MCDONOUGH GA
30253-8083
US

V. Phone/Fax

Practice location:
  • Phone: 770-256-5919
  • Fax:
Mailing address:
  • Phone: 770-256-5919
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2279H0200X
TaxonomyHome Health Registered Respiratory Therapist
License Number
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: