Provider Demographics
NPI:1053073999
Name:TARTT SUTTON, TONYA LASHAW
Entity Type:Individual
Prefix:
First Name:TONYA
Middle Name:LASHAW
Last Name:TARTT SUTTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:HENRY
Other - Middle Name:ROY
Other - Last Name:SUTTON
Other - Suffix:JR
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:184 HARPER ST
Mailing Address - Street 2:
Mailing Address - City:ATOKA
Mailing Address - State:TN
Mailing Address - Zip Code:38004-7634
Mailing Address - Country:US
Mailing Address - Phone:901-515-7517
Mailing Address - Fax:
Practice Address - Street 1:184 HARPER ST
Practice Address - Street 2:
Practice Address - City:ATOKA
Practice Address - State:TN
Practice Address - Zip Code:38004-7634
Practice Address - Country:US
Practice Address - Phone:901-515-7517
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-07
Last Update Date:2021-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN079226424172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver