Active NPI
Tawanna Easley, COSMETOLOGIST
- Prosthetic/Orthotic Supplier
- College Park, GA
National Provider Identifier
1073392130
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Prosthetic/Orthotic Supplier
- License
- CO093582
- Practice address
- 2900 Lajean Dr
College Park, GA 30349-4148 - Phone
- (678) 437-6348
- NPI assigned
- Sep 27, 2023
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Prosthetics Case Management | 1744P3200X | CO093582 | GA | |
| Prosthetic/Orthotic Supplier | 335E00000X | CO093582 | GA | Primary |
Addresses
Primary practice location
2900 Lajean Dr
College Park, GA 30349-4148
Mailing address
2900 Lajean Dr
College Park, GA 30349-4148
Phone (678) 437-6348
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| CO093582 | GA | MD | Prosthetics Case Management |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1695772800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1695772800000",
"number": "1073392130",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2900 LAJEAN DR",
"city": "COLLEGE PARK",
"state": "GA",
"postal_code": "303494148",
"telephone_number": "678-437-6348"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2900 LAJEAN DR",
"city": "COLLEGE PARK",
"state": "GA",
"postal_code": "303494148",
"telephone_number": "678-437-6348"
}
],
"practiceLocations": [],
"basic": {
"last_name": "EASLEY",
"first_name": "TAWANNA",
"credential": "COSMETOLOGIST",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2023-09-27",
"last_updated": "2023-09-27",
"certification_date": "2023-09-27",
"status": "A"
},
"taxonomies": [
{
"code": "1744P3200X",
"taxonomy_group": "",
"desc": "Specialist, Prosthetics Case Management",
"state": "GA",
"license": "CO093582",
"primary": false
},
{
"code": "335E00000X",
"taxonomy_group": "",
"desc": "Prosthetic/Orthotic Supplier",
"state": "GA",
"license": "CO093582",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in College Park, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 27, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.