Healthcare Provider Details

I. General information

NPI: 1427738418
Provider Name (Legal Business Name): TANGANIKA PAUL MCDONALD CNA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/24/2023
Last Update Date: 01/22/2024
Certification Date: 01/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

205 THOMAS BLVD
WARNER ROBINS GA
31093-3235
US

IV. Provider business mailing address

133 HIDDEN CREEK CIR
WARNER ROBINS GA
31088-5267
US

V. Phone/Fax

Practice location:
  • Phone: 855-203-5085
  • Fax:
Mailing address:
  • Phone: 478-867-9143
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code246RP1900X
TaxonomyPhlebotomy Technician
License Number22-1768
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License NumberCN0028910673
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: