| Doctor Name: | MRS. EMILY JANE TACKETT |
| NPI Number: | 1063871994 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | CPNP |
| License Number: | RN204462 |
| Business Practice Address: | 3950 Austell Rd Austell, GA - 301061121 |
| Business Phone Number: | 4707325201 |
| Business Fax Number: | 4707925209 |
| Mailing Address: | 3950 Austell Rd, AUSTELL |
| State: | GA |
| Postal Code: | 301061121 |
| Phone Number: | 4707325201 |
| Fax Number: | 4707925209 |
| NPI Enumeration Date: | 02/20/2016 |
| NPI Last Update Date: | 02/20/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LP0200X |
| License Number: | RN204462 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | GA |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Pediatrics |
| Taxonomy Definition: | |