Provider Demographics
NPI:1396230413
Name:ENOCH, TANSHA (RN)
Entity Type:Individual
Prefix:MISS
First Name:TANSHA
Middle Name:
Last Name:ENOCH
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12301 KENSINGTON TRL
Mailing Address - Street 2:
Mailing Address - City:LITHONIA
Mailing Address - State:GA
Mailing Address - Zip Code:30038-3282
Mailing Address - Country:US
Mailing Address - Phone:404-831-6845
Mailing Address - Fax:
Practice Address - Street 1:100 S MADISON ST
Practice Address - Street 2:
Practice Address - City:THOMASVILLE
Practice Address - State:GA
Practice Address - Zip Code:31792-5473
Practice Address - Country:US
Practice Address - Phone:229-236-0831
Practice Address - Fax:229-236-0871
Is Sole Proprietor?:No
Enumeration Date:2018-07-01
Last Update Date:2020-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN207426363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health