Provider Demographics
NPI:1902825342
Name:DRY, TONIA
Entity Type:Individual
Prefix:
First Name:TONIA
Middle Name:
Last Name:DRY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:TONIA
Other - Middle Name:
Other - Last Name:GRANTHAM
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PA
Mailing Address - Street 1:6 EXECUTIVE PARK DR NE
Mailing Address - Street 2:SUITE 10
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30329-2221
Mailing Address - Country:US
Mailing Address - Phone:404-321-9900
Mailing Address - Fax:
Practice Address - Street 1:6 EXECUTIVE PARK DR NE
Practice Address - Street 2:SUITE 10
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30329-2221
Practice Address - Country:US
Practice Address - Phone:404-321-9900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2016-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA004785363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA010946607AMedicaid
GA010946607MMedicaid
GA97WCHXPMedicare PIN
GA010946607MMedicaid
GA010946607AMedicaid