Provider Demographics
NPI:1114782638
Name:HENSON, TAMMY (PMHNP)
Entity Type:Individual
Prefix:
First Name:TAMMY
Middle Name:
Last Name:HENSON
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:627 TRESTLE RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:TOCCOA
Mailing Address - State:GA
Mailing Address - Zip Code:30577-9060
Mailing Address - Country:US
Mailing Address - Phone:706-244-1252
Mailing Address - Fax:
Practice Address - Street 1:1763 FERNSIDE DR
Practice Address - Street 2:
Practice Address - City:TOCCOA
Practice Address - State:GA
Practice Address - Zip Code:30577-8095
Practice Address - Country:US
Practice Address - Phone:706-282-4542
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-14
Last Update Date:2024-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN1292042084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry