Provider Demographics
NPI:1568941227
Name:COLVIN, TANIKA TOWNSON-SMITH (ATC)
Entity Type:Individual
Prefix:MRS
First Name:TANIKA
Middle Name:TOWNSON-SMITH
Last Name:COLVIN
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:TANIKA
Other - Middle Name:TOWNSON
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ATC
Mailing Address - Street 1:4225 UNIVERSITY AVE
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31907-5679
Mailing Address - Country:US
Mailing Address - Phone:256-506-3998
Mailing Address - Fax:
Practice Address - Street 1:4225 UNIVERSITY AVE
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31907-5645
Practice Address - Country:US
Practice Address - Phone:256-506-3998
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-13
Last Update Date:2018-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAT0032532255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer