Provider Demographics
NPI:1093958092
Name:HOLLEY, TAMARA CAROLYNN (BS)
Entity Type:Individual
Prefix:MRS
First Name:TAMARA
Middle Name:CAROLYNN
Last Name:HOLLEY
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1603 NASHVILLE HIGHWAY
Mailing Address - Street 2:
Mailing Address - City:LEWISBURG
Mailing Address - State:TN
Mailing Address - Zip Code:37091
Mailing Address - Country:US
Mailing Address - Phone:931-359-5802
Mailing Address - Fax:931-359-0148
Practice Address - Street 1:1603 NASHVILLE HIGHWAY
Practice Address - Street 2:
Practice Address - City:LEWISBURG
Practice Address - State:TN
Practice Address - Zip Code:37091
Practice Address - Country:US
Practice Address - Phone:931-359-5802
Practice Address - Fax:931-359-0148
Is Sole Proprietor?:No
Enumeration Date:2009-04-07
Last Update Date:2009-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator