Provider Demographics
NPI:1356234322
Name:LANKFORD, TINA
Entity type:Individual
Prefix:
First Name:TINA
Middle Name:
Last Name:LANKFORD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4000 SMITHTOWN RD UNIT 104
Mailing Address - Street 2:
Mailing Address - City:SUWANEE
Mailing Address - State:GA
Mailing Address - Zip Code:30024-6559
Mailing Address - Country:US
Mailing Address - Phone:770-695-7606
Mailing Address - Fax:
Practice Address - Street 1:4000 SMITHTOWN RD UNIT 104
Practice Address - Street 2:
Practice Address - City:SUWANEE
Practice Address - State:GA
Practice Address - Zip Code:30024-6559
Practice Address - Country:US
Practice Address - Phone:770-695-7606
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-29
Last Update Date:2025-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-185370163W00000X
GA171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
No163W00000XNursing Service ProvidersRegistered Nurse