Provider Demographics
NPI:1235392655
Name:RADNEY, TAMMY PITTS (LPN)
Entity Type:Individual
Prefix:
First Name:TAMMY
Middle Name:PITTS
Last Name:RADNEY
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1826 VETERANS BLVD
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:GA
Mailing Address - Zip Code:31021-3620
Mailing Address - Country:US
Mailing Address - Phone:478-272-1210
Mailing Address - Fax:478-274-5508
Practice Address - Street 1:1074 LAZY LN
Practice Address - Street 2:
Practice Address - City:RENTZ
Practice Address - State:GA
Practice Address - Zip Code:31075-3424
Practice Address - Country:US
Practice Address - Phone:478-984-1345
Practice Address - Fax:478-275-0813
Is Sole Proprietor?:No
Enumeration Date:2008-07-07
Last Update Date:2008-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPN069258164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse