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NPI Code Detail

MEDICARE: RENEE TOLLY MD

MEDICARE: RENEE TOLLY MD
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
1390200000XStudent in an Organized Health Care Education/Training Program
2207L00000XAnesthesiology Physician92769GA
3207LP3000XPediatric Anesthesiology Physician92769GA

General Provider Information

NPI Number : 1558893115
Entity Type Code : Individual
Provider Name (Legal Business Name) : RENEE TOLLY MD
Provider Business Mailing Address
First Line : 1405 CLIFTON RD NE
Second Line :
City : ATLANTA
State : GA
Zip : 30322-1060
Country : US
Telephone Number : 404-785-6670
Fax Number :
Provider Business Practice Location Address
First Line : 1405 CLIFTON RD NE
Second Line :
City : ATLANTA
State : GA
Zip : 30322-1060
Country : US
Telephone Number : 404-785-6670
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/31/2017
Last Update Date : 03/06/2026

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Directions to “ RENEE TOLLY MD” Practice Location

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