Provider Demographics
NPI:1376789958
Name:PERNELL, TONYA
Entity Type:Individual
Prefix:
First Name:TONYA
Middle Name:
Last Name:PERNELL
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 1:3816 CASPIAN DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31906-6200
Mailing Address - Country:US
Mailing Address - Phone:706-289-5776
Mailing Address - Fax:
Practice Address - Street 1:421 12TH ST
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31901-2522
Practice Address - Country:US
Practice Address - Phone:706-494-7776
Practice Address - Fax:706-494-7072
Is Sole Proprietor?:No
Enumeration Date:2009-01-02
Last Update Date:2009-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker