Individual
TAMOLETTE JANE ANDERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
C.R.N.A.
Contact information
Practice address
1700 MEDICAL WAY, SNELLVILLE, GA 30078-2195
(770) 979-9996
Mailing address
PO BOX 3559, SUWANEE, GA 30024-0993
(770) 979-9996
(770) 979-1202
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
R090293
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000691446B
—
GA
05
—
000691446D
—
GA
01
—
430032609
RAILROAD MEDICARE
GA
Enumeration date
11/10/2005
Last updated
05/04/2015
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