Provider Demographics
NPI:1730955923
Name:WILKINS, TAJANAI NAKYLAR ELIZABETH
Entity type:Individual
Prefix:
First Name:TAJANAI
Middle Name:NAKYLAR ELIZABETH
Last Name:WILKINS
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 1:503 MULBERRY ST
Mailing Address - Street 2:
Mailing Address - City:THOMASTON
Mailing Address - State:GA
Mailing Address - Zip Code:30286-2424
Mailing Address - Country:US
Mailing Address - Phone:706-741-5229
Mailing Address - Fax:
Practice Address - Street 1:108 WYNNBROOK DR
Practice Address - Street 2:
Practice Address - City:THOMASTON
Practice Address - State:GA
Practice Address - Zip Code:30286-1321
Practice Address - Country:US
Practice Address - Phone:706-648-8037
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-28
Last Update Date:2023-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARBT-23-257995106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician