Provider Demographics
NPI:1356979363
Name:SITOU, TAWA KALYTOU (FNP)
Entity type:Individual
Prefix:
First Name:TAWA
Middle Name:KALYTOU
Last Name:SITOU
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:831 FAIRWAYS CT STE A
Mailing Address - Street 2:
Mailing Address - City:STOCKBRIDGE
Mailing Address - State:GA
Mailing Address - Zip Code:30281-7278
Mailing Address - Country:US
Mailing Address - Phone:770-389-1925
Mailing Address - Fax:
Practice Address - Street 1:831 FAIRWAYS CT
Practice Address - Street 2:
Practice Address - City:STOCKBRIDGE
Practice Address - State:GA
Practice Address - Zip Code:30281-7278
Practice Address - Country:US
Practice Address - Phone:770-328-1925
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-27
Last Update Date:2021-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN220265363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty