Individual
MRS. EMILY JANE TACKETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CPNP
Contact information
Practice address
3950 AUSTELL RD, AUSTELL, GA 30106-1121
(470) 732-5201
(470) 792-5209
Mailing address
3950 AUSTELL RD, AUSTELL, GA 30106-1121
(470) 732-5201
(470) 792-5209
Taxonomy
Speciality
Code
Description
License number
State
363LP0200X
Pediatric Nurse Practitioner
Primary
RN204462
GA
Other
Enumeration date
02/20/2016
Last updated
02/20/2016
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