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General NPI Number Information
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NPI Number | 1003498197
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Entity Type | Organization
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Legal Business Name | TINY CLINIC, PC
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Dates
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Enumeration Date | 04/27/2021
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Last Update Date | 10/30/2025
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Provider Practice Location Address
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Address Line | 112 HEAD AVE
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City | TALLAPOOSA
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State | GA
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Zip | 30176-1219
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Country | US
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Telephone | 904-382-8911
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Fax | 470-329-0422
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Provider Business Mailing Address
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Address Line | 618 THORNTON RD STE 3-297
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City | LITHIA SPRINGS
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State | GA
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Zip | 30122-1518
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Country | US
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Telephone | 404-692-3189
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Fax | 470-329-0422
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Authorized Official
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Title or Position | OWNER / AUTHORIZED OFFICER
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Name | MARLANA JENESE WISE
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Credential | NP
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Telephone | 904-382-8911
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number |
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License Number State |
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