Provider Demographics
NPI:1093509887
Name:MCKOY, TANNISHEA VERONICA
Entity type:Individual
Prefix:
First Name:TANNISHEA
Middle Name:VERONICA
Last Name:MCKOY
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 BUTLER INDUSTRIAL DR APT 413
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:GA
Mailing Address - Zip Code:30132-0940
Mailing Address - Country:US
Mailing Address - Phone:470-989-6833
Mailing Address - Fax:
Practice Address - Street 1:296 MERCHANTS SQ
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:GA
Practice Address - Zip Code:30132-5029
Practice Address - Country:US
Practice Address - Phone:470-391-2300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-07
Last Update Date:2025-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician