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General NPI Number Information
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NPI Number | 1699282665
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Entity Type | Organization
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Legal Business Name | TRANSFORMATIONS PEDIATRIC HEALTH AND WELLNESS, LLC
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Dates
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Enumeration Date | 12/29/2017
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Last Update Date | 02/05/2021
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Provider Practice Location Address
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Address Line | 1448 LUCILE AVE SW
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City | ATLANTA
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State | GA
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Zip | 30310-1217
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Country | US
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Telephone | 585-752-9696
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Fax |
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Provider Business Mailing Address
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Address Line | 4449 NORTHSIDE PKWY NW APT 334
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City | ATLANTA
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State | GA
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Zip | 30327-5250
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Country | US
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Telephone | 585-752-9696
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Fax |
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Authorized Official
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Title or Position | NURSE PRACTITIONER
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Name | TENNISHA EDWARDS
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Credential | DNP, CPNP-PC
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Telephone | 585-752-9696
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | RN261933
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License Number State | GA
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