Provider Demographics
NPI:1871467936
Name:BUNTING, TANYA KENNEDY
Entity type:Individual
Prefix:
First Name:TANYA
Middle Name:KENNEDY
Last Name:BUNTING
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 SILVER LEAF DR
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30214-1033
Mailing Address - Country:US
Mailing Address - Phone:404-782-9025
Mailing Address - Fax:
Practice Address - Street 1:125 SILVER LEAF DR
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30214-1033
Practice Address - Country:US
Practice Address - Phone:404-782-9025
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-10-01
Last Update Date:2025-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral