Active NPI
Tamari Lightfoot, CSFA
- Surgical Physician Assistant
- Dallas, GA
National Provider Identifier
1700781259
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Surgical Physician Assistant
- License
- 100304913
- Practice address
- 10175 Dallas Acworth Hwy Ste 103-14
Dallas, GA 30132-9300 - Phone
- (678) 481-1647
- NPI assigned
- Oct 13, 2026
- Last updated
- Oct 13, 2026
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Surgical Physician Assistant | 363AS0400X | 100304913 | GA | Primary |
Addresses
Primary practice location
10175 Dallas Acworth Hwy Ste 103-14
Dallas, GA 30132-9300
Mailing address
3890 Floyd Rd Apt 12306
Austell, GA 30106-1787
Phone (678) 481-1647
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1791849600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1791849600000",
"number": "1700781259",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3890 FLOYD RD APT 12306",
"city": "AUSTELL",
"state": "GA",
"postal_code": "301061787",
"telephone_number": "678-481-1647"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "10175 DALLAS ACWORTH HWY STE 103-14",
"city": "DALLAS",
"state": "GA",
"postal_code": "301329300",
"telephone_number": "678-481-1647"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LIGHTFOOT",
"first_name": "TAMARI",
"credential": "CSFA",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2026-10-13",
"last_updated": "2026-10-13",
"certification_date": "2026-10-13",
"status": "A"
},
"taxonomies": [
{
"code": "363AS0400X",
"taxonomy_group": "",
"desc": "Physician Assistant, Surgical",
"state": "GA",
"license": "100304913",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}
Other providers in Dallas, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 13, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.