Provider Demographics
NPI:1275053340
Name:ATKINSON, DEVEANE TATANYA (NP)
Entity Type:Individual
Prefix:MRS
First Name:DEVEANE
Middle Name:TATANYA
Last Name:ATKINSON
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MRS
Other - First Name:DEVEANE
Other - Middle Name:T
Other - Last Name:ATKINSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:FNP
Mailing Address - Street 1:1620 OLD PEACHTREE RD NW
Mailing Address - Street 2:
Mailing Address - City:SUWANEE
Mailing Address - State:GA
Mailing Address - Zip Code:30024-2011
Mailing Address - Country:US
Mailing Address - Phone:678-779-0161
Mailing Address - Fax:
Practice Address - Street 1:1445 OLD MCDONOUGH HWY SE STE E
Practice Address - Street 2:
Practice Address - City:CONYERS
Practice Address - State:GA
Practice Address - Zip Code:30094
Practice Address - Country:US
Practice Address - Phone:770-922-9222
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-21
Last Update Date:2018-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA167706207Q00000X, 163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No163W00000XNursing Service ProvidersRegistered Nurse