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General NPI Number Information
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NPI Number | 1366153926
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Entity Type | Individual
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Provider Name | TIONNE NICOLE PETE
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Gender | Female
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Dates
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Enumeration Date | 12/05/2022
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Last Update Date | 07/24/2025
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Provider Practice Location Address
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Address Line | 1459 LANEY WALKER BLVD
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City | AUGUSTA
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State | GA
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Zip | 30912-3031
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Country | US
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Telephone | 706-721-7005
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Fax |
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Provider Business Mailing Address
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Address Line | 5410 NORTHLAKE CIR NE
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City | ATLANTA
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State | GA
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Zip | 30345-2846
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Country | US
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Telephone | 404-940-7231
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 18098
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License Number State | GA
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