MEDICARE: MRS. TONYA KATHLEEN HANCOCK 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
1	363LG0600X	Gerontology Nurse Practitioner	RN217057	GA

General Provider Information

NPI Number	:	1568163244
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. TONYA KATHLEEN HANCOCK NP

Provider Business Mailing Address
First Line	:	P.O. BOX 311 3201 MACON ROAD
Second Line	:	SUITE 139
City	:	COLUMBUS
State	:	GA
Zip	:	31906
Country	:	US
Telephone Number	:	706-577-1198
Fax Number	:

Provider Business Practice Location Address
First Line	:	4135 WINDTREE LN
Second Line	:
City	:	COLUMBUS
State	:	GA
Zip	:	31907-1817
Country	:	US
Telephone Number	:	706-577-1198
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/10/2023
Last Update Date	:	03/10/2023

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