Healthcare Provider Details

I. General information

NPI: 1154124550
Provider Name (Legal Business Name): TOMEKA CAUSEY CCMA,PT-C,CGSP,CAMS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/31/2025
Last Update Date: 03/31/2025
Certification Date: 03/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1957 LAKESIDE PKWY
TUCKER GA
30084-5881
US

IV. Provider business mailing address

PO BOX 479
AVONDALE ESTATES GA
30002-0479
US

V. Phone/Fax

Practice location:
  • Phone: 404-289-0310
  • Fax: 404-289-0314
Mailing address:
  • Phone: 404-289-0313
  • Fax: 404-289-0314

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code246RP1900X
TaxonomyPhlebotomy Technician
License NumberF4K5N3S4
License Number StateGA
# 3
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: