Provider Demographics
NPI:1144218405
Name:STRAUTHER, TAWANNA J (MD)
Entity Type:Individual
Prefix:DR
First Name:TAWANNA
Middle Name:J
Last Name:STRAUTHER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 742616
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-2616
Mailing Address - Country:US
Mailing Address - Phone:770-219-8420
Mailing Address - Fax:
Practice Address - Street 1:3931 MUNDY MILL RD
Practice Address - Street 2:SUITE A
Practice Address - City:OAKWOOD
Practice Address - State:GA
Practice Address - Zip Code:30566-3431
Practice Address - Country:US
Practice Address - Phone:770-848-9100
Practice Address - Fax:770-848-9101
Is Sole Proprietor?:No
Enumeration Date:2005-10-11
Last Update Date:2020-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA74106207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCH50164Medicare UPIN
NC2044800Medicare ID - Type Unspecified