Provider Demographics
NPI:1336101310
Name:MAXWELL, TANYA MARIE (ATC)
Entity Type:Individual
Prefix:
First Name:TANYA
Middle Name:MARIE
Last Name:MAXWELL
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2045 PEACHTREE RD NE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30309-1414
Mailing Address - Country:US
Mailing Address - Phone:678-732-1336
Mailing Address - Fax:404-605-0371
Practice Address - Street 1:2045 PEACHTREE RD NE
Practice Address - Street 2:700
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30309-1414
Practice Address - Country:US
Practice Address - Phone:404-350-3540
Practice Address - Fax:404-605-0371
Is Sole Proprietor?:No
Enumeration Date:2006-04-05
Last Update Date:2009-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAT0010622255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer