Provider Demographics
NPI:1962690404
Name:SANCHEZ, TONYA (PA-C)
Entity type:Individual
Prefix:MRS
First Name:TONYA
Middle Name:
Last Name:SANCHEZ
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1458 CHURCH ST STE B
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30030-1672
Mailing Address - Country:US
Mailing Address - Phone:404-376-4155
Mailing Address - Fax:404-508-5560
Practice Address - Street 1:1458 CHURCH ST STE B
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30030-1672
Practice Address - Country:US
Practice Address - Phone:404-508-2000
Practice Address - Fax:404-508-5560
Is Sole Proprietor?:No
Enumeration Date:2007-10-10
Last Update Date:2024-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA005069363AS0400X, 363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA400373OtherWELLCARE HEALTHCARE
GA326919821AMedicaid
GA005069OtherSTATE LICENSE
GA400373OtherWELLCARE HEALTHCARE