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General NPI Number Information
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NPI Number | 1487358990
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Entity Type | Individual
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Provider Name | ALANA BLOCKER TIERNEY PA-C
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Gender | Female
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Dates
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Enumeration Date | 03/28/2023
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Last Update Date | 06/18/2024
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Provider Practice Location Address
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Address Line | 1100 JOHNSON FERRY RD STE 510
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City | MARIETTA
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State | GA
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Zip | 30068-2794
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Country | US
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Telephone | 943-888-9006
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Fax |
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Provider Business Mailing Address
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Address Line | 6919 PEACHTREE DUNWOODY RD APT 444
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City | SANDY SPRINGS
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State | GA
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Zip | 30328-1736
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Country | US
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Telephone | 256-487-1113
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 11504
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License Number State | GA
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Taxonomy #3
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 11504
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License Number State | GA
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