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NPI Code Detail

MEDICARE: TIGEST TESHOME NP

MEDICARE: TIGEST TESHOME NP
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
1363L00000XNurse PractitionerAPRN11000286FL
2363LA2200XAdult Health Nurse PractitionerAPRN11000286FL
3363LA2200XAdult Health Nurse PractitionerRN245809GA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1558827162
Entity Type Code : Individual
Provider Name (Legal Business Name) : TIGEST TESHOME NP
Provider Business Mailing Address
First Line : PO BOX 746087
Second Line :
City : ATLANTA
State : GA
Zip : 30374-6087
Country : US
Telephone Number : 312-733-9730
Fax Number :
Provider Business Practice Location Address
First Line : 625 S MARIETTA PKWY SE
Second Line :
City : MARIETTA
State : GA
Zip : 30060-2748
Country : US
Telephone Number : 470-377-7228
Fax Number : 470-467-7583
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/19/2019
Last Update Date : 06/04/2024

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Practice Location Address:
625 S MARIETTA PKWY SE
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1528098639 — MS. MARGUERITE MARIE VARDMAN APRN
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1063684363 — MAVIS APPIAH KUBI APRN
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1538454368 — KATHY ELIZABETH LISHMAN FNP
Practice Location Address:
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1376083675 — KARINA T BAILEY
Practice Location Address:
625 S MARIETTA PKWY SE
MARIETTA, GA
30060-2748
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1447763339 — MINAL G PATEL FNP-C
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625 S MARIETTA PKWY SE
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Directions to “ TIGEST TESHOME NP” Practice Location

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