Provider Demographics
NPI:1902352677
Name:BANKS, TORY M (FNP)
Entity Type:Individual
Prefix:MS
First Name:TORY
Middle Name:M
Last Name:BANKS
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1405 FRANKLIN GTWY SE
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30067-8721
Mailing Address - Country:US
Mailing Address - Phone:770-951-5400
Mailing Address - Fax:678-388-1399
Practice Address - Street 1:1405 FRANKLIN GTWY SE
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30067-8721
Practice Address - Country:US
Practice Address - Phone:770-951-5400
Practice Address - Fax:770-951-5408
Is Sole Proprietor?:No
Enumeration Date:2016-08-31
Last Update Date:2016-11-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GAF0216972363LF0000X
GARN131866363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily