Individual provider Active NPI

Tamari Lightfoot, CSFA

  • Surgical Physician Assistant
  • Dallas, GA
National Provider Identifier
1700781259
Registry record updated Oct 13, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgical Physician AssistantTaxonomy code 363AS0400X
License
100304913 Issued in GA
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, 2026By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 13, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
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.

Verify at the official NPI Registry.