Provider Demographics
NPI:1346637543
Name:HUTCHINSON, TANISHA (MD)
Entity Type:Individual
Prefix:
First Name:TANISHA
Middle Name:
Last Name:HUTCHINSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5559 GLENRIDGE DR APT 1109
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30342-7202
Mailing Address - Country:US
Mailing Address - Phone:404-993-1320
Mailing Address - Fax:
Practice Address - Street 1:2285 ASQUITH AVE SW STE 200
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30008-6092
Practice Address - Country:US
Practice Address - Phone:404-993-1320
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-04-25
Last Update Date:2024-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA88586207YS0123X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YS0123XAllopathic & Osteopathic PhysiciansOtolaryngologyFacial Plastic Surgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program