Provider Demographics
NPI:1285893610
Name:OSCAR F TANAKA PHD, PA
Entity type:Organization
Organization Name:OSCAR F TANAKA PHD, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:OSCAR
Authorized Official - Middle Name:F
Authorized Official - Last Name:TANAKA
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:404-352-4348
Mailing Address - Street 1:2045 PEACHTREE RD NE
Mailing Address - Street 2:SUITE 150
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30309-1414
Mailing Address - Country:US
Mailing Address - Phone:404-352-4348
Mailing Address - Fax:404-352-4334
Practice Address - Street 1:2045 PEACHTREE RD NE
Practice Address - Street 2:SUITE 150
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30309-1414
Practice Address - Country:US
Practice Address - Phone:404-352-4348
Practice Address - Fax:404-352-4334
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-02
Last Update Date:2008-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA002048251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000722389AMedicaid