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General NPI Number Information
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NPI Number | 1801958012
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Entity Type | Individual
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Provider Name | GLENDA YANIRA ALVAREZ TARNOFF PA-C
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Gender | Female
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Dates
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Enumeration Date | 12/14/2006
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Last Update Date | 01/15/2025
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Provider Practice Location Address
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Address Line | 3925 PEACHTREE RD NE STE 300
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City | BROOKHAVEN
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State | GA
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Zip | 30319-5257
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Country | US
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Telephone | 404-231-4231
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 769609
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City | ROSWELL
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State | GA
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Zip | 30076-8224
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Country | US
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Telephone | 770-921-4811
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Fax | 770-921-7943
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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 | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 004183
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 4183
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License Number State | GA
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