Provider Demographics
NPI:1659320786
Name:ATKINSON, TANGELA C (MD)
Entity Type:Individual
Prefix:
First Name:TANGELA
Middle Name:C
Last Name:ATKINSON
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 1:176 CHARLES HARDY PKWY UNIT C
Mailing Address - Street 2:
Mailing Address - City:HIRAM
Mailing Address - State:GA
Mailing Address - Zip Code:30141-1836
Mailing Address - Country:US
Mailing Address - Phone:678-945-8200
Mailing Address - Fax:
Practice Address - Street 1:176 CHARLES HARDY PKWY UNIT C
Practice Address - Street 2:
Practice Address - City:HIRAM
Practice Address - State:GA
Practice Address - Zip Code:30141-1836
Practice Address - Country:US
Practice Address - Phone:678-945-8200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-08
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL23906207Q00000X
GA077534207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51533181OtherBCBS
AL009935906Medicaid
LA1523470Medicaid
MS02154090Medicaid
MS02154090Medicaid