MEDICARE: ZACHARY RYAN TIPPENS APRN

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	363LF0000X	Family Nurse Practitioner	APRN-NP239947	GA
2	163W00000X	Registered Nurse	RN239947	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	RN239947	OTHER	GA	STATE OF GEORGIA
2	F02200533	OTHER		AMERICAN ACADEMY OF NURSE PACTITIONERS

General Provider Information

NPI Number	:	1760003842
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ZACHARY RYAN TIPPENS APRN

Provider Business Mailing Address
First Line	:	720 TRANSIT AVE
Second Line	:
City	:	CANTON
State	:	GA
Zip	:	30114-2540
Country	:	US
Telephone Number	:	770-720-7000
Fax Number	:	770-720-7055

Provider Business Practice Location Address
First Line	:	720 TRANSIT AVE
Second Line	:
City	:	CANTON
State	:	GA
Zip	:	30114-2540
Country	:	US
Telephone Number	:	770-720-7000
Fax Number	:	770-720-7055

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

Provider Enumeration Date	:	04/30/2020
Last Update Date	:	04/28/2026

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