Provider Demographics
NPI:1801958012
Name:TARNOFF, GLENDA YANIRA ALVAREZ (PA-C)
Entity type:Individual
Prefix:
First Name:GLENDA
Middle Name:YANIRA ALVAREZ
Last Name:TARNOFF
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:GLENDA
Other - Middle Name:Y
Other - Last Name:ALVAREZ TARNOFF
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:PO BOX 769609
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30076-8224
Mailing Address - Country:US
Mailing Address - Phone:770-921-4811
Mailing Address - Fax:770-921-7943
Practice Address - Street 1:3925 PEACHTREE RD NE STE 300
Practice Address - Street 2:
Practice Address - City:BROOKHAVEN
Practice Address - State:GA
Practice Address - Zip Code:30319-5257
Practice Address - Country:US
Practice Address - Phone:404-231-4231
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-14
Last Update Date:2025-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA004183363AM0700X
GA4183363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA581762046OtherGA CLINIC GROUP TAX I.D.
GAGRP 2768Medicare ID - Type UnspecifiedGA CLINIC GROUP #