Provider Demographics
NPI:1184337982
Name:TOMBERLIN, PAIGE (NP)
Entity type:Individual
Prefix:
First Name:PAIGE
Middle Name:
Last Name:TOMBERLIN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1745 CITY CIRCLE RD BLDG B
Mailing Address - Street 2:
Mailing Address - City:BAXLEY
Mailing Address - State:GA
Mailing Address - Zip Code:31513-7059
Mailing Address - Country:US
Mailing Address - Phone:912-705-6653
Mailing Address - Fax:912-705-3172
Practice Address - Street 1:1745 CITY CIRCLE RD BLDG B
Practice Address - Street 2:
Practice Address - City:BAXLEY
Practice Address - State:GA
Practice Address - Zip Code:31513-7059
Practice Address - Country:US
Practice Address - Phone:912-705-6653
Practice Address - Fax:912-705-3172
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-27
Last Update Date:2025-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN098245363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner