Provider Demographics
NPI:1811056104
Name:TOLBERT, TAMEKA R (NP)
Entity type:Individual
Prefix:MRS
First Name:TAMEKA
Middle Name:R
Last Name:TOLBERT
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:TAMEKA
Other - Middle Name:N
Other - Last Name:RANSOM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3495 PIEDMONT ROAD, NE
Mailing Address - Street 2:NINE PIEDMONT CENTER
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30305
Mailing Address - Country:US
Mailing Address - Phone:404-364-7070
Mailing Address - Fax:770-439-8641
Practice Address - Street 1:1150 POWDER SPRINGS STREET, SUITE 50
Practice Address - Street 2:KAISER PERMANENTE AT COBB COUNTY EMPLOYEE HEALTH CLINIC
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30064
Practice Address - Country:US
Practice Address - Phone:770-528-1924
Practice Address - Fax:770-439-8641
Is Sole Proprietor?:No
Enumeration Date:2006-12-06
Last Update Date:2022-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN109522363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000828341EMedicaid
GA50BBGVKMedicare ID - Type Unspecified