Provider Demographics
NPI:1720409493
Name:FAVORS, TONYA
Entity Type:Individual
Prefix:
First Name:TONYA
Middle Name:
Last Name:FAVORS
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 1:323 HOSANNA CIR
Mailing Address - Street 2:
Mailing Address - City:AMERICUS
Mailing Address - State:GA
Mailing Address - Zip Code:31719-8277
Mailing Address - Country:US
Mailing Address - Phone:229-347-2480
Mailing Address - Fax:
Practice Address - Street 1:311 S LEE ST
Practice Address - Street 2:APT C
Practice Address - City:AMERICUS
Practice Address - State:GA
Practice Address - Zip Code:31709-3971
Practice Address - Country:US
Practice Address - Phone:229-347-2480
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-12-26
Last Update Date:2013-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA13471797103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent