Basic Information
| Provider Information | |||||||||
| NPI: | 1366800112 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GORDON | ||||||||
| FirstName: | TANYA | ||||||||
| MiddleName: | LYNN | ||||||||
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| Credential: | APRN NP-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2020 PEACHTREE RD NW | ||||||||
| Address2: | |||||||||
| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303091426 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4043507323 | ||||||||
| FaxNumber: | 4043507694 | ||||||||
| Practice Location | |||||||||
| Address1: | 2020 PEACHTREE RD NW | ||||||||
| Address2: | |||||||||
| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303091426 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4043502020 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/08/2016 | ||||||||
| LastUpdateDate: | 01/31/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | RN181470 | GA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.