Provider Demographics
NPI:1922454701
Name:BERNADIN, TASHINEA (DO)
Entity Type:Individual
Prefix:DR
First Name:TASHINEA
Middle Name:
Last Name:BERNADIN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:DR
Other - First Name:TASHINEA
Other - Middle Name:
Other - Last Name:LEE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:730 GLYNN ST S
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30214-2050
Mailing Address - Country:US
Mailing Address - Phone:770-460-3650
Mailing Address - Fax:
Practice Address - Street 1:730 GLYNN ST S
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30214
Practice Address - Country:US
Practice Address - Phone:770-460-3650
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-10
Last Update Date:2019-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA078993207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine