Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0200X | Nurse Practitioner - Pediatrics | RN143313 | GA |
NPI | 1013001973 |
---|---|
Provider Name | Ms. Tanya S Wilcox |
First Address | Kennesaw, GA 30152-3938 |
Second Address | Kennesaw, GA 30152-3938 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/10/2006 |
Last Update Date | 05/12/2016 |