# TINY CLINIC, PC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1003498197
- **Authorized official:** MARLANA JENESE WISE NP (OWNER / AUTHORIZED OFFICER)
- **Authorized official phone:** (904) 382-8911

## Contact information

- **Practice address:** 112 HEAD AVE, TALLAPOOSA, GA 30176-1219
- **Practice address phone:** (904) 382-8911
- **Practice address fax:** (470) 329-0422
- **Mailing address:** 618 THORNTON RD STE 3-297, LITHIA SPRINGS, GA 30122-1518
- **Mailing address phone:** (404) 692-3189
- **Mailing address fax:** (470) 329-0422

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 363L00000X | Nurse Practitioner | — | — | Yes |

## Other

- **Enumeration date:** 04/27/2021
- **Last updated:** 10/30/2025