Provider Demographics
NPI:1083367379
Name:TRAIL, TANYA J (CPM)
Entity Type:Individual
Prefix:
First Name:TANYA
Middle Name:J
Last Name:TRAIL
Suffix:
Gender:F
Credentials:CPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2719 HAWAII CT
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30033-2315
Mailing Address - Country:US
Mailing Address - Phone:678-488-9754
Mailing Address - Fax:
Practice Address - Street 1:2719 HAWAII CT
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30033-2315
Practice Address - Country:US
Practice Address - Phone:678-488-9754
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-27
Last Update Date:2022-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife