Provider Demographics
NPI:1326073628
Name:SOLOMON, TANIA WIEKER (PA-C)
Entity Type:Individual
Prefix:
First Name:TANIA
Middle Name:WIEKER
Last Name:SOLOMON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:TANIA
Other - Middle Name:LYNN
Other - Last Name:WIEKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:1335 CHURCH ST
Mailing Address - Street 2:B1
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30030-1500
Mailing Address - Country:US
Mailing Address - Phone:404-377-0775
Mailing Address - Fax:
Practice Address - Street 1:1365B CLIFTON RD NE
Practice Address - Street 2:SUITE B1400
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30322-1013
Practice Address - Country:US
Practice Address - Phone:404-778-4898
Practice Address - Fax:404-778-4006
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA002975363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
97WCFPVMedicare ID - Type Unspecified