Provider Demographics
NPI:1164503108
Name:D'ELENA, TAMIKO LIN (PA-C)
Entity Type:Individual
Prefix:PROF
First Name:TAMIKO
Middle Name:LIN
Last Name:D'ELENA
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:TAMIKO
Other - Middle Name:L
Other - Last Name:KOLKJEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:6300 HOSPITAL PKWY
Mailing Address - Street 2:SUITE 450
Mailing Address - City:JOHNS CREEK
Mailing Address - State:GA
Mailing Address - Zip Code:30097
Mailing Address - Country:US
Mailing Address - Phone:770-227-2222
Mailing Address - Fax:770-227-2220
Practice Address - Street 1:6300 HOSPITAL PKWY
Practice Address - Street 2:STE 450
Practice Address - City:JOHNS CREEK
Practice Address - State:GA
Practice Address - Zip Code:30097
Practice Address - Country:US
Practice Address - Phone:770-227-2222
Practice Address - Fax:770-227-2220
Is Sole Proprietor?:No
Enumeration Date:2006-10-18
Last Update Date:2014-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI1601000462231H00000X
GA004550363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA04BDCMZMedicare ID - Type Unspecified
GA202I970580Medicare UPIN