Healthcare Provider Details

I. General information

NPI: 1801958012
Provider Name (Legal Business Name): GLENDA YANIRA ALVAREZ TARNOFF PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: GLENDA YANIRA ALVAREZ PA

II. Dates (important events)

Enumeration Date: 12/14/2006
Last Update Date: 09/27/2026
Certification Date: 09/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 TOWNE LAKE PKWY
WOODSTOCK GA
30189-1585
US

IV. Provider business mailing address

1600 TOWNE LAKE PKWY
WOODSTOCK GA
30189-1585
US

V. Phone/Fax

Practice location:
  • Phone: 770-517-1022
  • Fax:
Mailing address:
  • Phone: 770-517-1022
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number4183
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number004183
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: