Provider Demographics
NPI:1053985218
Name:CHU, THASHA ANN (DNP, AGACNP-BC)
Entity type:Individual
Prefix:DR
First Name:THASHA
Middle Name:ANN
Last Name:CHU
Suffix:
Gender:F
Credentials:DNP, AGACNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3332 CLUBLAND DR
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30068-2504
Mailing Address - Country:US
Mailing Address - Phone:404-790-5403
Mailing Address - Fax:
Practice Address - Street 1:3332 CLUBLAND DR
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30068-2504
Practice Address - Country:US
Practice Address - Phone:404-790-5403
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-13
Last Update Date:2021-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN225666363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care