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NPI Code Detail

MEDICARE: TAMOLETTE JANE ANDERSON C.R.N.A.

MEDICARE: TAMOLETTE JANE ANDERSON C.R.N.A.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1367500000XCertified Registered Nurse AnesthetistR090293GA

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1430032609OTHERGARAILROAD MEDICARE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1417938945
Entity Type Code : Individual
Provider Name (Legal Business Name) : TAMOLETTE JANE ANDERSON C.R.N.A.
Provider Business Mailing Address
First Line : PO BOX 3559
Second Line :
City : SUWANEE
State : GA
Zip : 30024-0993
Country : US
Telephone Number : 770-979-9996
Fax Number : 770-979-1202
Provider Business Practice Location Address
First Line : 1700 MEDICAL WAY
Second Line :
City : SNELLVILLE
State : GA
Zip : 30078-2195
Country : US
Telephone Number : 770-979-9996
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/10/2005
Last Update Date : 05/04/2015

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