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General NPI Number Information
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NPI Number | 1922600279
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Entity Type | Individual
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Provider Name | EVELYN LEMA TANKOH MRN, APRN, AGNP-BC
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Gender | Female
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Dates
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Enumeration Date | 11/11/2020
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Last Update Date | 09/19/2025
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Provider Practice Location Address
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Address Line | 7130 MOUNT ZION BLVD STE 14B
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City | JONESBORO
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State | GA
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Zip | 30236-2566
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Country | US
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Telephone | 770-585-2384
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Fax | 470-288-0223
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Provider Business Mailing Address
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Address Line | 1975 HIGHWAY 54 W STE 205
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City | PEACHTREE CITY
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State | GA
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Zip | 30269-4794
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Country | US
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Telephone | 770-585-2384
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Fax | 470-288-0223
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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 | 163WG0000X
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Taxonomy Name | General Practice Registered Nurse
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License Number | RN118032
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 163WG0600X
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Taxonomy Name | Gerontology Registered Nurse
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License Number | RN118032
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License Number State | GA
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Taxonomy #3
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | RN118032
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License Number State | GA
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