| Doctor Name: | MS. TANYA WILCOX |
| NPI Number: | 1013001973 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | NP |
| License Number: | RN143313 |
| Business Practice Address: | 5150 Stilesboro Rd Nw Suite 220 Kennesaw, GA - 301527744 |
| Business Phone Number: | 7704248222 |
| Business Fax Number: | 7704249962 |
| Mailing Address: | 5150 Stilesboro Rd Nw, Suite 220 KENNESAW |
| State: | GA |
| Postal Code: | 301527744 |
| Phone Number: | 7704248222 |
| Fax Number: | 7704249962 |
| NPI Enumeration Date: | 10/03/2006 |
| NPI Last Update Date: | 09/04/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LP0200X |
| License Number: | RN143313 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | GA |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Pediatrics |
| Taxonomy Definition: | |