1811056104 NPI number — MRS. TAMEKA R TOLBERT NP

Table of content: MRS. TAMEKA R TOLBERT NP (NPI 1811056104)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1811056104 NPI number — MRS. TAMEKA R TOLBERT NP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TOLBERT
Provider First Name:
TAMEKA
Provider Middle Name:
R
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
NP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
RANSOM
Provider Other First Name:
TAMEKA
Provider Other Middle Name:
N
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1811056104
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/14/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3495 PIEDMONT ROAD, NE
Provider Second Line Business Mailing Address:
NINE PIEDMONT CENTER
Provider Business Mailing Address City Name:
ATLANTA
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30305
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
404-364-7070
Provider Business Mailing Address Fax Number:
770-439-8641

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1150 POWDER SPRINGS STREET, SUITE 50
Provider Second Line Business Practice Location Address:
KAISER PERMANENTE AT COBB COUNTY EMPLOYEE HEALTH CLINIC
Provider Business Practice Location Address City Name:
MARIETTA
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30064
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
770-528-1924
Provider Business Practice Location Address Fax Number:
770-439-8641
Provider Enumeration Date:
12/06/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363L00000X , with the licence number:  RN109522 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 000828341E , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".