Provider Demographics
NPI:1275796559
Name:PRINGLE, TAWNYA LYNETTE
Entity Type:Individual
Prefix:
First Name:TAWNYA
Middle Name:LYNETTE
Last Name:PRINGLE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3196 MOUNT ZION RD
Mailing Address - Street 2:APT 804
Mailing Address - City:STOCKBRIDGE
Mailing Address - State:GA
Mailing Address - Zip Code:30281-9304
Mailing Address - Country:US
Mailing Address - Phone:678-458-7630
Mailing Address - Fax:
Practice Address - Street 1:3196 MOUNT ZION RD
Practice Address - Street 2:APT 804
Practice Address - City:STOCKBRIDGE
Practice Address - State:GA
Practice Address - Zip Code:30281-9304
Practice Address - Country:US
Practice Address - Phone:678-458-7630
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-07
Last Update Date:2008-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN155811364SF0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SF0001XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistFamily Health