Provider Demographics
NPI:1336780840
Name:LARODE, TUNIKA MARIAH THERESA (CNM)
Entity Type:Individual
Prefix:
First Name:TUNIKA
Middle Name:MARIAH THERESA
Last Name:LARODE
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:TUNIKA
Other - Middle Name:MARIAH THERESA
Other - Last Name:MAYERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:20 DREW CT
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:GA
Mailing Address - Zip Code:30157-6994
Mailing Address - Country:US
Mailing Address - Phone:347-844-8732
Mailing Address - Fax:
Practice Address - Street 1:4181 HOSPITAL DR NE STE 104
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:GA
Practice Address - Zip Code:30014-2541
Practice Address - Country:US
Practice Address - Phone:770-385-8954
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-05
Last Update Date:2019-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN245026367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife