Provider Demographics
NPI:1952789745
Name:MCCAULEY, TANESHA MARIE (DO)
Entity Type:Individual
Prefix:DR
First Name:TANESHA
Middle Name:MARIE
Last Name:MCCAULEY
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1824 DEFOOR AVE NW APT 4211
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30318-3071
Mailing Address - Country:US
Mailing Address - Phone:919-949-6386
Mailing Address - Fax:
Practice Address - Street 1:3999 AUSTELL RD STE 901
Practice Address - Street 2:
Practice Address - City:AUSTELL
Practice Address - State:GA
Practice Address - Zip Code:30106-1160
Practice Address - Country:US
Practice Address - Phone:770-809-3032
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-12
Last Update Date:2023-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101022070207Q00000X
GA86353207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine